中国循证儿科杂志 ›› 2021, Vol. 16 ›› Issue (3): 214-217.

• 论著 • 上一篇    下一篇

新生儿腹部超声门静脉积气征阳性的病例对照研究

 胡娅, 华子瑜, 韦红, 徐珍娥   

  1. 重庆医科大学附属儿童医院新生儿科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,儿童感染免疫重庆市重点实验室  重庆,400014
  • 收稿日期:2021-04-06 修回日期:2021-06-25 出版日期:2021-06-25 发布日期:2021-06-25
  • 通讯作者: 徐珍娥

Portal vein gas-positive on abdominal ultrasonography in neonates: A case-control study

HU Ya, HUA Ziyu, WEI Hong, XU Zhen-e   

  1. Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing 400014,  China
  • Received:2021-04-06 Revised:2021-06-25 Online:2021-06-25 Published:2021-06-25
  • Contact: XU Zhen-e

摘要: 背景: 对于有血便、腹胀等表现且腹部超声门静脉积气征(PVG)阳性的新生儿,临床上仍存在将食物蛋白过敏性直肠结肠炎(FPIPC)误诊为NEC的情况。 目的: 比较NEC和FPIPC的临床资料及腹部超声表现,并分析NEC的相关因素。 设计: 病例对照研究。 方法: 纳入2019年1月1日至12月31日在重庆医科大学附属儿童医院住院、至少1次腹部超声检查显示PVG阳性的新生儿,根据出院时第一诊断分为NEC组和FPIPC组。从电子病历中截取患儿的一般资料、临床表现和体征、实验室检查结果、腹部超声报告等,行影响因素分析。 主要结局指标: 腹部超声检查PVG阳性的新生儿中确诊为NEC的影响因素。 结果: NEC组68例,FPIPC组42例。NEC组胎龄、入院日龄小于FPIPC组,出生体重和入院体重低于FPIPC组,腹胀、反应低下、肠鸣音减弱的百分比高于FPIPC组,N%高于FPIPC组,CRP升高和PCT异常的百分比高于FPIPC组;FPIPC组腹泻的百分比高于NEC组;差异均有统计学意义。腹部超声检查:NEC组肠蠕动减慢、腹腔积液的比例高于FPIPC组,差异均有统计学意义;PVG阳性检出日龄在两组间差异无统计学意义;腹部超声复查(NEC组67例,FPIPC组37例)3 d内PVG未消失的比例在两组间差异无统计学意义。Logistic回归发现,腹部肠鸣音减弱(OR=14.7,95%CI:2.6~82.2,P=0.002)、CRP>10 mg·L-1(OR=24.7,95%CI:1.4~431.7,P=0.028)、超声示肠蠕动减慢(OR=26.9,95%CI:1.8~389.9,P=0.016)与NEC相关。 结论: 新生儿腹部超声PVG阳性时,需结合胎龄、出生体重、临床表现、炎症指标、腹部超声特点等进行鉴别诊断,当腹部肠鸣音减弱、CRP增高、腹部超声示肠蠕动减慢时,需警惕NEC。

关键词: 新生儿, 门脉积气, 坏死性小肠结肠炎, 食物蛋白过敏性直肠结肠炎, 超声

Abstract: Background: In clinical practice, food protein-induced proctocolitis (FPIPC) might still be misdiagnosed as neonatal necrotizing enterocolitis (NEC) for neonates with bloody stool and abdominal distension and positive portal vein gas (PVG) by abdominal ultrasound. Objective: To compare the clinical data and abdominal ultrasound examination results of NEC and FPIPC and to analyze the related factors of NEC. Design: Case-control study. Methods: Newborns with PVG positive by abdominal ultrasound were included from the inpatient settings of Children's Hospital of Chongqing Medical University from January 1, 2019 to December 31, 2019. According to the first diagnosis at discharge, they were divided into NEC group and FPIPC group. The general information, clinical manifestations and signs, the results of laboratory examination and abdominal ultrasound reports of the children were collected from the electronic medical records and the factors with statistical significance and clinical value were screened out for Logistic regression analysis. Main outcome measures: Factors associated with the diagnosis of NEC in neonates with positive PVG on abdominal ultrasound. Results: There were 68 cases in NEC group and 42 cases in FPIPC group. The gestational age, birth weight and the age and weight at the admission in the NEC group were lower than those in the FPIPC group. The percentage of abdominal distention, low reaction and reduced bowel tone, neutrophils proportion, and the percentage of elevated CRP and abnormal PCT in NEC group were higher than those in FPIPC group. The percentage of diarrhea in FPIPC group was higher than that in NEC group(P<0.05). Abdominal ultrasound examination showed the proportion of intestinal peristalsis and peritoneal effusion in NEC group was higher than that in FPIPC group (P<0.05).There was no significant difference in the age of PVG detection between the two groups. There was no significant difference in the proportion of PVG that did not disappear within 3 days after abdominal ultrasound re-examination (67 cases in NEC group and 37 cases in FPIPC group) between the two groups. Logistic regression showed that decreased abdominal bowel sounds (OR=14.7, 95%CI: 2.6~82.2, P=0.002), CRP>10 mg·L-1 (OR=24.7, 95%CI:1.4~431.7, P=0.028) and slower intestinal peristalsis(OR=26.9, 95%CI: 1.853~389.9, P=0.016) were associated with NEC. Conclusion: When abdominal ultrasound on neonates showed positive PVG, gestational age, birth weight, clinical manifestations, inflammation, abdominal ultrasound characteristics should be combined to make differentiate diagnosis. NEC should be paid attention when there were weakened abdominal bowel sounds, elevated CRP increases, and slower bowel movements by abdominal ultrasound.

Key words: Neonates, Portal vein gas, Necrotizing enterocolitis, Food protein-induced proctocolitis, Ultrasound