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中国循证儿科杂志

中国循证儿科杂志 ›› 2018, Vol. 13 ›› Issue (6): 434-437.

• 论著 • 上一篇    下一篇

坏死性小肠结肠炎早产儿发生脑损伤的危险因素分析

魏慧,严恺,朱晓芸,曹云,陈超,王来栓   

  1. 复旦大学附属儿科医院 上海，201102
  • 收稿日期:2018-09-11 修回日期:2019-11-22 出版日期:2018-12-25 发布日期:2018-12-25
  • 通讯作者: 王来栓

Risk factors for brain injury in preterm infants with necrotizing enterocolits

WEI Hui，YAN Kai，ZHU Xiao-yun，CAO Yun，CHEN Chao, WANG Lai-shuan   

  1. Department of Neonatology，Children's Hospital of Fudan University，Shanghai 201102，China
  • Received:2018-09-11 Revised:2019-11-22 Online:2018-12-25 Published:2018-12-25
  • Contact: WANG Lai-shuan

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摘要： 目的分析坏死性小肠结肠炎(NEC)早产儿发生脑损伤的危险因素。方法回顾性纳入2012年1月至2017年8月复旦大学附属儿科医院新生儿科收治的NEC早产儿（胎龄＜37周），修正Bell-NEC分级达 NEC Ⅱ期及以上。以纠正胎龄近足月时的颅脑MRI评分作为早期脑损伤的判断指标，白质评分≥7或灰质评分≥5分作为MRI阳性（MRI+）组，余为MRI阴性（MRI-）组。比较两组的临床特征，分析NEC早产儿发生早期脑损伤的危险因素，并通过拟合曲线确定危险因素的界值，采用受试者工作特征(ROC)曲线评价判断指标对脑损伤的预测价值。结果共110例NEC早产儿进入本文分析，MRI+49例，MRI-61例。两组出生胎龄、出生体重、Apgar 1 min评分、产前激素使用、机械通气时间、NEC手术、NEC发病日龄、NEC 24 h内CRP异常（≥8 mg·L-1）比例、血培养阳性率差异均无统计学意义，两组NEC 24 h内WBC异常（<4×109·L-1或>20×109·L-1）比例、PLT水平、修正Bell分期Ⅲ期比例和肠穿孔发生率差异均有统计学意义。 NEC 24 h内WBC<4×109·L-1或>20×109·L-1（OR=4.3，95%CI：1.6~11.5）、合并肠穿孔（OR=4.7，95%CI：1.3~17.4）是脑损伤的独立危险因素。WBC ROC曲线分析显示，当WBC≤8×109·L-1时，曲线下面积(AUC)为0.722，最佳界值为5.2×109·L-1，预测脑损伤的敏感度和特异度分别为68.4%和71.1%；当WBC>8×109·L-1时，AUC为0.695，最佳界值为15.5×109·L-1，预测脑损伤的敏感度和特异度分别为61.1%和77.1%。结论NEC 24 h内WBC异常升高和降低、合并肠穿孔为NEC早产儿脑损伤的独立危险因素；NEC 24 h内WBC<5.2×109·L-1或>15.5×109·L-1对脑损伤有一定的预测价值。

Abstract: ObjectiveTo analyze the risk factors for brain injury in preterm infants with necrotizing enterocolits (NEC).MethodsThe retrospective study was conducted in preterm infants with NEC (Bell stage ≥Ⅱ) admitted to the neonatal intensive care unit, Children's Hospital of Fudan University during January 1st, 2012 to August 31st, 2017. The included patients were divided into positive cranial MRI group with white matter grades≥7 or grey matter grades ≥5 and negative group--the rest of the patients, according to MRI grades. Then compare the clinical characteristics between two groups to analyse the risk factors for brain brain injury in preterm infants with NEC. The fitting curve was used to determine the cutoff and the receiver operating characteristics curve (ROC) was used to evaluate the predictive value of risk factors for brain injury.ResultsA total of 110 preterm infants with NEC were enrolled, including 49 in MRI positive group and 61 in negtive group. There were no statistical difference in GA, BW, antenatal steroid use, Apgar 1 min, duration of mechanical ventilation, operation, onset age of NEC, C reaction protein (CRP) and blood culture within 24 h after NEC between the two groups（P>0.05）. However, the incidence of white blood cell (WBC) <4×109·L-1 or > 20 ×109·L-1 and platelet (PLT) level within 24 h after NEC, the rates of Bell stage Ⅲ and intestinal perforation were significantly different （P<0.05）. WBC < 4×109·L-1 or > 20 ×109·L-1 within 24 h after NEC(OR=4.3，95%CI：1.6-11.5) and intestinal perforation(OR=4.7，95%CI：1.3-17.4) were the independent risk factors for brain injury. The area under curve (AUC) of ROC was 0.722 when WBC ≤ 8×109·L-1, and the corresponding cutoff, sensitivity and specificity were 5.2×109·L-1, 68.4% and 71.1%, respectively. While WBC > 8×109·L-1, the AUC was 0.695 and the corresponding cutoff, sensitivity and specificity were 15.5×109·L-1, 61.1% and 77.1%, respectively.ConclusionThe change of WBC within 24 h after NEC and intestinal perforation consist the independent risk factors for brain injury in preterm infants with NEC. WBC < 5.2×109·L-1 or > 15.5×109·L-1 during the 24 h after NEC has certain value to predict brain injury.

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