血浆D-乳酸水平与新生儿坏死性小肠结肠炎预后的关系

目的 探讨血浆D-乳酸水平与新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)预后的关系.方法 采用病例对照研究方法.选择2007年1月至2010年10月入住本院新生儿重症监护病房诊断为NECⅡ、Ⅲ期的早产儿104例(NEC组)；同期因其他疾病入院的早产非NEC患儿104例(对照组),与NEC组匹配纠正胎龄、性别和出生体重,按1∶1比例进行配对.NEC组患儿于NEC确诊后24 h内,对照组患儿于相应日龄取血,采用酶联免疫吸附试验检测血浆D-乳酸水平,采用受试者工作特性曲线确定D-乳酸阳性标准.根据此标准将NEC组分为D-乳酸升高组与D-乳酸正常组,x2检验比较组间并发症及病死率.根据患儿病情转归将NEC组分为死亡组和存活组,t检验比较不同组间D-乳酸水平差异.结果 NEC组104例患儿中,NECⅡ期63例(60.6％),NECⅢ期41例(39.4％)；存活88例(84.6％),死亡16例(15.4％).NECⅢ期组D-乳酸水平最高,为(35.4±29.1)μg/ml,其次是NECⅡ期组,为(29.5±16.2)μg/ml,对照组最低(3.7±18.4)μg/ml],差异均有统计学意义(F=5.97,P＜0.05).受试者工作特性曲线分析显示,D-乳酸水平≥6 μg/ml为阳性标准,按此标准,NEC组血浆D-乳酸水平升高者87例(83.7％,87/104).D-乳酸水平升高者新生儿危重病例评分明显低于正常者(80.9±22.6)分与(95.8±20.5)分,t=2.417,P＜0.05],而合并新生儿败血症的比例48.3％(42/87)与5.9％(1/17),x2=11.538,P＜0.05]及病死率27.6％(24/87)与5.9％(1/17),x2=7.146,P＜0.05]较高.NEC组死亡患儿与存活患儿D-乳酸水平(43.2±13.5) μg/ml与(21.9±22.9) μg/ml,t=4.572,P＜0.05]、新生儿危重病例评分(82.4±29.1)分与(90.6±21.3)分,t=2.409,P＜0.05]以及合并败血症的比例68.8％(11/16)与38.6％ (34/88),x2=3.445,P＜0.05]差异均有统计学意义.结论 血浆D-乳酸水平与NEC预后相关,能较好地反映NEC患儿的病情及预后.

Relationship between plasma D-lactate levels and prognosis of neonatal necrotizing enterocolitis

Objective To investigate the relationship between plasma D-lactate levels and prognosis in newborns with neonatal necrotizing enterocolitis (NEC).Methods One hundred and four premature infants with NEC (stase Ⅱ and Ⅲ ) and another 104 premature infants without NEC admitted into Quanzhou Children's Hospital for other diseases from January 2007 to October 2010 were selected into this case control study.The gestational age,gender and birth weight of patients in the two groups were matched.NEC patients' bloods were collected within 24 hours after NEC was confirmed and blood samples of the control group were collected at the corresponding age.Enzymelinked immunosorbent assay was used to detect the plasma D-lactate level.Receiver operating characteristic curve was used to confirm the criteria of D-lactate positive,according to which,the NEC group was divided into high D-lactate group and normal D-lactate group,and the mortality and complication rate of the two groups were compared with x2 test.And NEC group was subdivided into death group and survive group according to the prognosis of the patients,and the difference of D-lactate level between the two groups were compared with t test.Results Among the NEC group,there were 63 cases (60.6％) of stage Ⅱ and 41 (39.4％) cases of stage Ⅲ ; 88 (84.6％) survived infants and 16 (15.4％) dead infants.D-lactate level was (35.4 ± 29.1) μg /ml in stage Ⅲ NEC group,(29.5±16.2) μg/ml in stage Ⅱ NEC group and (3.7±18.4) μg/ml in control group; there were statistical differences between each other(F=5.97,P＜0.05).Receiver operating characteristic curve analysis showed that if 6 μg/ml was set as the borderline,there were 87 cases(83.7％,87/104) with high D-lactate patients in NEC group,whose neonatal critical illness scoring (NCIS) was 80.9±22.6,significantly lower than that of normal D-lactate patients ( 95.8 ± 20.5) (t =2.417,P＜ 0.05),and higher neonatal septicemia rate (48.3％,42/87) and mortality (27.6％,24/87) compared with those (5.9％,1/17) and (5.9％,1/17)] of normal D-lactate patients(x2 =11.539 and 7.146,P＜0.05,respectively).In NEC group,compared with the survived infants,the D-lactate level (43.2±13.5) μg/ml vs (21.9 ± 22.9) μg/ml,t =4.572,P＜0.05] and the rate of septicemia 68.8％ (11/16) vs 38.6％ (34/88),x2 =3.445,P＜0.05] were higher in dead patients,and NCIS (82.4± 29.1 vs 90.6 ± 21.3,t =2.409,P＜0.05) was lower.Conctusions The level of plasma D-lactate related to the prognosis of neonatal NEC and which might be a good indicator for its prognosis and severity.