肠型脂肪酸结合蛋白检测在足月新生儿坏死性小肠炎中的临床意义

Clinical significance of serum intestinal fatty acid-binding protein in full-term infants with necrotizing enterocolitis

摘要:

目的 探讨肠型脂肪酸结合蛋白(I-FABP)在足月新生儿坏死性小肠炎(NEC)中的临床应用价值.方法 2012 年2 月至2014 年1 月确诊为NEC 的41 例足月新生儿为病例组,其中Ⅰ期患儿24 例,Ⅱ ~ Ⅲ期患儿17 例;同期确诊为非消化系统疾病的62 例患儿为对照组.采用酶联免疫吸附法(ELISA)检测各组患儿血清I-FABP 和C 反应蛋白(CRP)水平.采用受试者工作特征曲线(ROC)对I-FABP 诊断NEC 进行评估.结果 病例组不同分级患儿血清I-FABP 水平均显著高于对照组(均P<0.05),且Ⅱ ~ Ⅲ期组显著高于Ⅰ期患儿(P<0.05); I-FABP 血清标志物 ROC 曲线下面积(AUC)为0.85(95%CI:0.78~0.92),最佳诊断截点值为2.25 ng/mL,该截点值下诊断NEC 的敏感性为80.49%,特异性为70.19%.病例组与对照组患儿血清CRP 水平差异无统计学意义(P>0.05).结论 血清I-FABP 在NEC 患儿早期(Ⅰ期)已显著升高,并与病情严重程度存在相关性,可作为诊断NEC 的参考指标.

Abstract:

Objective To evaluate the clinical value of intestinal fatty acid-binding protein (Ⅰ-FABP) in full-termnew born infants with necrotizing enterocolitis (NEC). Methods Forty-one full-term infants with a confirmed diagnosisof NEC from February 2012 to January 2014 were recruited as case group (stage I:24 cases; stage Ⅱ-Ⅲ:17 cases).Sixty-two children diagnosed with non-digestive diseases in the same period were recruited as the control group. Serumlevels of Ⅰ-FABP and C-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. The diagnosticvalue of I-FABP for NEC was assessed using the receiver operating characteristic (ROC) curve. Results Stage Ⅰ andstage Ⅱ-Ⅲ cases in the case group had significantly higher serum Ⅰ-FABP levels than the control group (P<0.05), andstage Ⅱ-Ⅲ cases had significantly higher serum Ⅰ-FABP levels than stage Ⅰ cases (P<0.05). The area under the ROCcurve for serum Ⅰ-FABP was 0.85 (95% CI:0.78-0.92), with the optimal cut-off point of 2.25 ng/mL. Under this cut-offpoint, the sensitivity and specificity were 80.49% and 70.19%, respectively. There was no significant difference in serum CRP level between the case and control groups (P>0.05). Conclusions In newborn infants with NEC, serum I-FABPlevel increases significantly in stage I, and it is correlated with the disease severity. Therefore, serum I-FABP can beused as a biomarker for the diagnosis of NEC.