C-反应蛋白、降钙素原在新生儿坏死性小肠结肠炎患儿的水平变化及临床意义

目的 探讨C-反应蛋白（CRP）、降钙素原（PCT）在新生儿坏死性小肠结肠炎（NEC）患儿的水平变化及意义。方法 142例NEC新生儿根据修正Bell分期分为Ⅰ期组（40例）、Ⅱ期组（72例）和Ⅲ期组（30例）。手术治疗的18例均为Ⅲ期，保守治疗的124例中Ⅲ期12例、余为Ⅰ、Ⅱ期。各组于治疗前、治疗后次日及恢复期检测CRP和PCT。结果 治疗前、治疗后次日及恢复期的Ⅲ期组CRP高于Ⅰ、Ⅱ期组，Ⅱ、Ⅲ期组治疗后次日的CRP高于治疗前，Ⅲ期组治疗后次日的PCT高于治疗前（P < 0.05）；Ⅱ、Ⅲ期组恢复期的CRP、PCT低于Bell同期的治疗前、治疗后次日（P < 0.05）。Ⅲ期组的呼吸衰竭发生率和机械通气使用率高于Ⅰ、Ⅱ期组（P < 0.05），Ⅲ期组的脓毒症发生率高于Ⅱ期组（P < 0.05）；仅Ⅲ期患儿发生消化道穿孔（10例）和肠狭窄（8例）。治疗后次日的CRP对Ⅲ期NEC的发生有预测价值（P < 0.05）；治疗前及治疗后次日的CRP对于NEC手术具有预测价值（P < 0.05）。结论 CRP、PCT水平变化监测有助于Ⅱ、Ⅲ期NEC的早期诊断，CRP可能作为预测Ⅲ期NEC发生及手术的辅助指标。

Changes in C-reactive protein and procalcitonin levels in neonates with necrotizing enterocolitis and their clinical significance

Objective To study the changes in C-reactive protein (CRP) and procalcitonin (PCT) levels in neonates with necrotizing enterocolitis (NEC) and their clinical significance. Methods According to the modified Bell's staging criteria, 142 neonates with NEC were divided into stage I group (n=40), stage Ⅱ group (n=72), and stage Ⅲ group (n=30). All the 18 neonates who underwent surgical treatment had stage Ⅲ NEC, and among the 124 neonates who underwent conservative treatment, 12 had stage Ⅲ NEC and the others had stage I or Ⅱ NEC. CRP and PCT were measured before treatment, on the next day after treatment, and during the recovery stage. Results Before treatment, on the next day after treatment, and during the recovery stage, the stage Ⅲ group had a higher level of CRP than the stage I and stage Ⅱ groups (P < 0.05). On the next day after treatment, the stage Ⅱ and stage Ⅲ groups had an increase in CRP (P < 0.05), and the stage Ⅲ group had an increase in PCT (P < 0.05). The stage Ⅱ and stage Ⅲ groups had lower CRP and PCT in the recovery stage than before treatment and on the next day after treatment (P < 0.05). The stage Ⅲ group had higher incidence rate of respiratory failure and rate of mechanical ventilation than the stage I and stage Ⅱ groups (P < 0.05), and the stage Ⅲ group had a higher incidence rate of sepsis than the stage Ⅱ group (P=0.010). Gastrointestinal perforation and intestinal stenosis were observed in 10 and 8 neonates respectively in the stage Ⅲ group. CRP on the next day after treatment had a value in predicting stage Ⅲ NEC (P < 0.05), and CRP before treatment and on the next day after treatment had a value in predicting the need for surgery (P < 0.05). Conclusions Levels of CRP and PCT and their changes can help with the early diagnosis of Bell stage Ⅱ/Ⅲ NEC, and CRP can be used to predict the development of stage Ⅲ NEC and the need for surgery.