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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (2): 119-123.DOI: 10.3969/j.issn.1673-5501.2023.02.008

• 论著 • 上一篇    下一篇

新生儿坏死性小肠结肠炎并发肠穿孔危险因素的病例对照研究

李小玉1,邓春2   

  1.  1 重庆医科大学附属儿童医院新生儿科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室重庆，400014；2 重庆医科大学附属永川医院儿科重庆，402160
  • 收稿日期:2022-11-02 修回日期:2023-05-08 出版日期:2023-04-25 发布日期:2023-05-19
  • 通讯作者: 邓春

Risk factors for intestinal perforation in neonates with necrotizing enterocolitis：A case-control study

LI Xiaoyu1, DENG Chun2   

  1. 1 Department of Neonatology, Children's Hospital of Chongqing Medical University; National Clinical Research Center For Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China; 2 Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
  • Received:2022-11-02 Revised:2023-05-08 Online:2023-04-25 Published:2023-05-19
  • Contact: DENG Chun, email: dengcgcb@163.com

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摘要： 背景:新生儿坏死性小肠结肠炎（NEC）并发肠穿孔可能导致新生儿不良结局。 目的:分析新生儿NEC并发肠穿孔的危险因素。 设计:病例对照研究。 方法:回顾性纳入2011年1月至2021年12月在重庆医科大学附属儿童医院新生儿中心收治的确诊为NEC的患儿，选取修正BellNEC≥Ⅱ期的病例，并发肠穿孔的NEC新生儿为NEC并发肠穿孔组，未并发肠穿孔的NEC新生儿按照1∶1配比随机抽样组成对照组。比较两组的临床特征，分析NEC并发肠穿孔的危险因素，并通过ROC曲线确定危险因素的界值，并评价危险因素对NEC并发肠穿孔的预测价值。 主要结局指标:新生儿NEC并发肠穿孔的危险因素。 结果:研究期间NEC并发肠穿孔组和对照组各153例，单因素分析结果显示，两组出生体重、胎龄以及小于胎龄儿、发热、低血压、腹胀、便血、血小板减少症、低蛋白血症、高胆红素血症、低纤维蛋白原血症、肾功能损害、凝血功能障碍、动脉导管未闭、诊断NEC前使用布洛芬、诊断NEC前1周内使用多巴胺的占比差异均有统计学意义(P均＜0.05)。多因素Logistic回归分析结果显示，腹胀（OR=17.869，95%CI：4.972~64.213）、便血（OR=4.836，95%CI：1.773~13.188）、血小板减少症（OR=16.657，95%CI：6.173~44.943）、高胆红素血症（OR=4.485，95%CI：1.809~11.120）、低纤维蛋白原血症（OR=5.034，95%CI：1.505~16.832）和败血症（OR=12.385，95%CI：4.714~32.537）是NEC并发肠穿孔的独立危险因素。ROC曲线分析显示，6项独立危险因素及其联合对NEC并发肠穿孔均有预测价值（P均<0.05），以6项危险因素联合预测的ROC曲线下面积最大（0.961）。 结论:腹胀、便血、血小板减少症、高胆红素血症、低纤维蛋白原血症、败血症是NEC并伴发肠穿孔的危险因素。

关键词: 新生儿坏死性小肠结肠炎, 肠穿孔, 危险因素

Abstract: Background:Intestinal perforation in neonates with necrotizing enterocolitis（NEC） may lead to adverse neonatal outcomes. ObjectiveTo analyze the risk factors for intestinal perforation in neonates with necrotizing enterocolitis. Design:Casecontrol study Methods:The retrospective study was conducted in infants with NEC(Bell stage≥Ⅱ) admitted to the neonatal department, Children's Hospital of Chongqing Medical University during January 1st, 2011 to December 31st, 2021. The positive group was 153 NEC with intestinal perforation. By 1:1 random proportioning method,153 NEC with nonintestinal perforation were enrolled in negative group. The clinical characteristics between two groups were compared to analyze the risk factors for intestinal perforation in neonates with necrotizing enterocolitis. The fitting curve was used to determine the cutoff and the receiver operating characteristics curve(ROC) was used to evaluate the predictive value of risk factors for intestinal perforation. Main outcome measures:The risk factors of intestinal perforation in neonates with necrotizing enterocolitis. Results:There were significant differences in birth weight, gestational age, small for gestational age infants, fever, hypotension, abdominal distension, bloody stools, thrombocytopenia, hypoproteinemia, hyperbilirubinemia, hypofibrinogenemia, renal impairment, coagulopathy, patent ductus arteriosus, proportion of ibuprofen usage before the diagnosis of NEC and proportion of dopamine usage within 1 week before the diagnosis of NEC in positive group and negative group(P＜0.05). Abdominal distension （OR=17.869，95%CI：4.97264.213）, blood in stool （OR=4.836，95%CI：1.77313.188）, thrombocytopenia （OR=16.657，95%CI：6.17344.943）, hyperbilirubinemia （OR=4.485，95%CI：1.80911.120）, hypofibrinogenia （OR=5.034，95%CI：1.50516.832）, sepsis （OR=12.385，95%CI：4.714~32.537）were the independent risk factors for intestinal perforation. ROC curve analysis showed that the combination of 6 independent risk factors and 6 risk factors had predictive value for intestinal perforation in neonates with necrotizing enterocolitis(P<0.05). The combination of the 6 independent risk factors mentioned above has the highest predictive value for intestinal perforation in neonates with necrotizing enterocolitis. The area under the curve of ROC was 0.961. Conclusions:Abdominal distension, blood in stool, thrombocytopenia, hyperbilirubinemia, hypofibrinogenia, sepsis were the independent risk factors for intestinal perforation.

Key words: Neonatal necrotizing enterocolitis, Intestinal perforation, Risk factors