早产儿出生早期粪便钙卫蛋白水平变化及临床意义

Fecal calprotectin levels in preterm infants during the early neonatal period

摘要:

目的：探讨早产儿生后早期粪便钙卫蛋白（fecal calprotectin，FC）水平及影响因素，寻找早产儿胃肠道损伤的早期诊断指标。方法：将38例胎龄为29～33周的早产儿按早产原因分为胎膜早破（premature rapture of membrane，PROM）组、自发性早产(spontaneous preterm birth,SPB)组及有医学指征早产(indicated preterm birth，IPB)组，收集出生后第1次胎便及生后第3天最后1次粪便（以下简称为第1次和第2次粪便），用ELISA法测定FC水平。结果：38例早产儿第1次与第2次FC水平差异无统学计意义（P>0.05）。PROM组第1次FC水平明显高于IPB组（P0.05）。结论：胎膜早破及出生窒息促进早产儿胃肠道分泌FC，生后早期FC水平可反映早产儿早期胃肠道喂养状况，可作为评价早产儿生后早期消化道功能的指标。

Abstract:

OBJECTIVE: To explore whether fecal calprotectin (f-calprotectin, FC) may be an early marker for the identification of gastrointestinal injury in preterm infants by measuring FC concentration and changes of FC concentration in infants with different perinatal factors. METHODS: FC concentration was measured using ELISA in 76 samples (50-100 mg) obtained from 38 preterm infants (gestation 29 to 33 weeks), at birth and on the third day after birth (the 1st and the 2nd FC levels). The infants were classified into three groups according to the reason for preterm birth: premature rupture of membranes (PROM; n=13), spontaneous preterm birth (SPB; n=5) and indicated preterm birth (IPB; n=20). RESULTS: There were no significant differences between the 1st and 2nd FC levels in the 38 infants. The 1st FC level in the PROM group was significantly higher than that in the IPB group (P<0.05). The 1st FC level in infants whose mothers received antenatal antibiotics treatment was significantly lower. Infants born by cesarean section had a significantly lower 1st FC level than those born by vaginal delivery (P<0.05). Both the 1st and 2nd FC levels in infants with feeding intolerance were significantly higher than in infants with feeding tolerance (P<0.05). The 2nd FC level was negatively correlated with 1 min Apgar score (r=-0.3, P<0.05). CONCLUSIONS: Premature rupture of membranes and perinatal asphyxia may lead to an increase in the excretion of FC in preterm infants. FC may be used as a marker for early evaluation of gastrointestinal conditions in preterm infants.