背景:本研究旨在评估血清肠脂肪酸结合蛋白(I-FABP)的诊断潜力,粪便钙卫蛋白(FC),和粪便人β-防御素2(hBD2)在预测早产儿坏死性小肠结肠炎(NEC)中的作用。
方法:对胎龄<32周的新生儿进行前瞻性队列研究,怀疑NEC,在2021年6月至2022年12月期间注册。血清I-FABP,FC,粪便hBD2水平根据NEC怀疑进行测量,诊断通过放射学检查或外科手术证实。血清I-FABP的诊断精度,FC,粪便hBD2使用多变量逻辑回归模型进行评估。
结果:该研究包括70名新生儿(45名男性,25名女性),有30个正在发展的NEC(40%的第三阶段,n=12;60%第二阶段,对照组n=18)和40。NEC患者的血清I-FABP和FC水平显着升高(4.76ng/mL和521.56µg/g粪便,分别)比其他诊断的那些(1.38ng/mL和213.34µg/g粪便,这两种生物标志物分别为p=0.05)。II期NEC新生儿的粪便hBD2水平(376.44ng/g粪便)高于III期NEC新生儿和对照组(336.87ng/g和339.86ng/g粪便,分别为;p<0.05)。在进展到III期NEC的婴儿中未观察到这种增加。使用>2.54ng/mL的血清I-FABP阈值产生76.7%的灵敏度,87.5%的特异性,82.1%阳性预测值(PPV),阴性预测值(NPV)为83.3%。对于FC(截止值>428.99µg/g粪便),相应的值是76.7%的灵敏度,67.5%的特异性,63.9%PPV,和79.4%的净现值。
结论:血清I-FABP和FC水平对早期NEC检测有价值,并提供对疾病严重程度的见解。低粪便hBD2水平表明对管腔细菌的反应不足,可能使这些婴儿更容易发生NEC发育或恶化。
BACKGROUND: This study aimed to assess the diagnostic potential of serum intestinal fatty acid-binding protein (I-FABP), fecal calprotectin (FC), and fecal human β-defensin 2 (hBD2) in predicting necrotizing enterocolitis (NEC) in preterm infants.
METHODS: A prospective cohort of neonates with a gestational age < 32 weeks, suspected of NEC, was enrolled between June 2021 and December 2022. Serum I-FABP, FC, and fecal hBD2 levels were measured upon NEC suspicion, and diagnosis was confirmed through radiological examination or surgical intervention. Diagnostic precision of serum I-FABP, FC, and fecal hBD2 was assessed using a logistic regression model with multiple variables.
RESULTS: The study included 70 neonates (45 males, 25 females), with 30 developing NEC (40% Stage III, n = 12; 60% Stage II, n = 18) and 40 in the control group. NEC patients exhibited significantly higher serum I-FABP and FC levels (4.76 ng/mL and 521.56 µg/g feces, respectively) than those with other diagnoses (1.38 ng/mL and 213.34 µg/g feces, respectively; p ˂ 0.05 for both biomarkers). Stage II NEC neonates showed elevated fecal hBD2 levels (376.44 ng/g feces) than Stage III NEC neonates and controls (336.87 ng/g and 339.86 ng/g feces, respectively; p ˂ 0.05). No such increase was observed in infants progressing to Stage III NEC. Using a serum I-FABP threshold of > 2.54 ng/mL yielded 76.7% sensitivity, 87.5% specificity, 82.1% positive predictive value (PPV), and 83.3% negative predictive value (NPV). For FC (cutoff > 428.99 µg/g feces), corresponding values were 76.7% sensitivity, 67.5% specificity, 63.9% PPV, and 79.4% NPV.
CONCLUSIONS: Serum I-FABP and FC levels are valuable for early NEC detection and provide insights into disease severity. Low fecal hBD2 levels suggest an inadequate response to luminal bacteria, potentially rendering these infants more susceptible to NEC development or exacerbation.