极低出生体质量儿输注悬浮红细胞后粪便钙卫蛋白的变化研究

目的　分析极低出生体质量儿在输注悬浮红细胞72 h内粪便钙卫蛋白的变化。方法　选取2016年1月—2017年1月云南省第一人民医院新生儿重症监护病房出生体质量<1 500 g的极低出生体质量儿27例为研究对象。将患儿符合输血指征、输注过悬浮红细胞为输血组（19例），未接受输血患儿为未输血组（8例）。两组患儿均查血常规中的红细胞比容；未输血组患儿每24 h采集1次粪便，共采集4次；输血组患儿采集输血前最后1次粪便和输血后24、48、72 h粪便，测定患儿粪便中的钙卫蛋白。结果　输血组的红细胞比容低于未输血组（t=-5.114，P<0.001）。输血后24、48、72 h粪便钙卫蛋白高于输血前，输血后24 h粪便钙卫蛋白低于输血后48、72 h，输血后48 h粪便钙卫蛋白低于输血后72 h（P<0.05）。输血组粪便钙卫蛋白随时间的变化趋势的曲线拟合分析显示，粪便钙卫蛋白随时间的变化呈线性上升趋势（F=33.390，P<0.001）。未控制初始粪便钙卫蛋白水平时，红细胞比容与粪便钙卫蛋白变化幅度呈负相关（r=-0.696，P=0.001）。控制初始粪便钙卫蛋白水平后，红细胞比容与粪便钙卫蛋白变化幅度也呈负相关（r=-0.653，P=0.003）。结论　输血后，极低出生体质量儿肠道内的钙卫蛋白随时间的变化明显上升，而钙卫蛋白对肠道炎性应答的发生有很强的预警作用，所以在输注悬浮红细胞后，尤其贫血程度重的极低出生体质量儿可能会诱发肠道内炎性反应，从而增加发生坏死性小肠结肠炎的风险。

Fecal Calprotectin in Response to Transfusion of Red Blood Cell Suspension in Very Low Birth Weight Infants

Objective　To analyze the changes of fecal calprotectin in very low birth weight infants（VLBWI） within 72 h after receiving transfusion of red blood cell （RBC） suspension.Methods　We enrolled 27 VLBWI（birth weight <1 500 g） from NICU，the First People's Hospital of Yunnan Province from January 2016 to January 2017 and divided them into transfusion group（19 with blood transfusion indication receiving RBC suspension transfusion） and non transfusion group（8 did not receive RBC suspension transfusion）.The hematocrit （HCT） was detected.And fecal calprotectin was measured in feces of both groups collected concurrently.In the non transfusion group，1 stools were collected every 24 h for 4 times，and the children in the blood transfusion group collected the last 1 stools before and after blood transfusion，and the feces in 24 h，48 h and 72 h after transfusion.Results　The mean HCT of the transfusion group was lower than that of the control group （t= -5.114，P<0.001）.The 4 measurement results of the fecal calprotectin level for the transfusion group differed significantly（P<0.05），to be specific，the fecal calprotectin level was the lowest at baseline，then increased successively at 24 h，48 h，72 h after RBC suspension transfusion（P<0.05）.Curve fitting analysis demonstrated that the fecal calprotectin level for the transfusion group increased over time（F=33.390，P<0.001）；HCT was found to be negatively correlated increasing with fecal calprotectin level either when the baseline fecal calprotectin level was controlled（r=-0.653，P=0.003） or not（r=-0.696，P=0.001）.Conclusion　After receiving transfusion of RBC suspension，the level of fecal calprotectin of VLBWI was increasing significantly over time.The fecal calprotectin level is of great significance in predicting the intestinal inflammatory responses.For VLBWI，especially those with severe anemia，RBC suspension transfusion might induce intestinal inflammatory reactions，which in turn could increase the risk of having necrotizing enterocolitis.