Changes And Clinical Significance Of Serum Amyloid A And C-Reactive Protein Levels In Neonates With Necrotizing Colitis

Background and ObjectiveNeonatal necrotizing enterocolitis(NEC)is an acute intestinal inflammatory disease,which occurs in 2% ～ 5% of premature and low weight infants and is one of the main causes of high neonatal mortality in neonatal intensive care units(NICU).With the continuous development of perinatal medicine,more and more premature infants and low-weight infants survived,but NEC still has high morbidity and mortality.Previous studies have shown that the incidence of NEC in very low birth weight(VLBW)is 4.5% ～ 8.7%,and the mortality rate in very low birth weight(VLBW)is 30% ～ 40.5%,among which the mortality rate in NEC children requiring surgery is 40.5%.The mortality rate in ultra-low birth weight infants is 41% ～50.9%,and 50.9% of NEC infants requiring surgery.At present,clinical diagnosis of NEC mainly depends on imaging examination,abdominal examination and other means,but it is not specific,and some positive results are only shown in the continuous progress of the disease,so the new biological monitoring indicators provide a basis for the diagnosis of NEC.This study was aimed to investigate the application of serum amyloid A(SAA)and the combination of SAA and C-reactive protein(CRP)in the early diagnosis of NEC.The clinical data and the changes of serum amyloid A and C-reactive protein levels in 50 children were analyzed,and the application value of SAA,SAA and CRP combined detection in early diagnosis of NEC was further discussed.MethodsSerum samples were collected from children with acute NEC who were admitted to Department of Pediatric Surgery and Neonatal Intensive Care Unit of Henan Provincial People’s Hospital from February 2019 to February 2020.Serum samples of children in the control group were matched and collected during the same period.The concentrations of SAA and CRP in each group were detected by rate method and turbidity immunoassay,respectively.The clinical data and detection index data of the children were summarized and sorted,and the children with NEC were divided into groups according to clinical color ultrasound,abdominal orthostatic plain film results and abdominal physical examination,and the changes of serum concentrations of SAA and CRP in the NEC group and the control group were analyzed.SPSS23.0software was used to analyze and process the data.Turkey method was used for comparison between two groups,and one-way analysis of variance was used for comparison between multiple groups.P<0.05 was considered statistically significant.Results:1.The difference of birth weight between NEC children at different stages and those in the control group was statistically significant(P<0.05),and the weight of the control group was higher than that of the NEC group.2.The CRP level of NEC II/III group at 24 h,48h and 72 h was higher than that of NEC I group and control group,and the difference was statistically significant(P<0.05).3.The SAA level of NEC II/III group at 0h,24 h,48h and 72 h was higher than that of NEC I group and control group at the same period,with statistical significance(P<0.05).4.The predictive value of 24 h SAA for NEC II/III period was significantly different(P<0.05).5.0h SAA,0h combined detection(CRP+SAA),48 h SAA had predictive value on the occurrence of NEC stage I(P<0.05).Conclusion:1.The timely detection of SAA is of certain value for the diagnosis of NEC,but of little value for the specific staging of NEC.The continuous detection of SAA level is of certain value for the specific staging of NEC.2.Continuous detection of CRP in low birth weight infants is of certain value for NEC staging,but the fluctuation range of CRP is smaller than that of SAA.The sustained high level of CRP in the late stage and the relatively short sustained high level of SAA can further indicate the therapeutic effect of NEC.3.The timely combined detection of low weight infants(SAA+CRP)has a certain predictive value for the early diagnosis of NECI stage.