新生儿坏死性小肠结肠炎血浆谷氨酰胺浓度变化及临床意义

目的探讨血浆谷氨酰胺(Gln)浓度与新生儿坏死性小肠结肠炎(NEC)的关系。方法选取2002年10月至2003年10月福建省妇幼保健院住院治疗的NEC患儿16例，以同期住院的性别相同，年龄、胎龄、出生体重相当的非NEC患儿16例为对照组，采用反向高效液相色谱法测定血浆Gln值，观察两组间差异；以多因素分析的方法判定血浆Gln浓度与NEC的关系。结果NEC患儿血浆Gln浓度为(021±008)mmol/L，对照组为(035±014)mmol/L，差异有显著性意义(P<005)。控制了缺氧和感染因素的影响后，NEC组和对照组的血浆Gln浓度的边缘估计均值及95%可信区间分别为：0216mmol/L(0150~0282mmol/L)和0344mmol/L(0278~0410mmol/L)。两组校正均值比较，差异有显著性意义(P=0032)。在单因素分析筛选出关联因素的基础上，建立多因素条件Logistic回归模型，结果显示血浆Gln浓度是NEC的危险因素，OR值为13342(2006~88735)。结论NEC患儿血浆Gln浓度降低，低浓度的血浆Gln是NEC发生的危险因素。

The reduced plasma glutamine concentration in infants with necrotizing enterocolitis.

AbstractObjectiveTo determine the relationship between the plasma levels of glutamine(Gln) and NEC.MethodsWe chose sixteen infants who developed NEC from October 2002 to October 2003. We also chose sixteen non NEC infants as the controls,who were of the same sex,age,correspond gestational age and birth weight.We measured the plasma levels of Gln of these infants and control ones by RP HPLC,and observed the plasma levels of Gln.Then we determined the relationship between the plasma levels of Gln and NEC after controlling the possible confounding bias by multivariate analysis.ResultsThe mean plasma level of Gln in NEC was 02108±00813mmol/L,which was significantly lower than controls (03490±01388 mmol/L)(P<005).Adjusted mean plasma levels and 95% confidence interval of Gln in NEC and control group were 0216 mmol/L(0150~0282mmol/L) and 0344 mmol/L(0278~0410mmol/L),respectively.There was significant difference between two groups(P=0032).The univariate χ2 analysis showed that variables:plasma level of Gln,hypoxia and infection,were significantly different between two groups;and the variables:plasma level of Gln and hypoxia,were the risk factors for NEC in conditional multiple regression.ConclusionInfants who developed NEC have reduced level of Gln,and the reduced level of Gln may predispose to the illness.