| Objective To explore the value of serum biomarkers and MD7 in predicting the timing of surgery for neonatal necrotizing enterocolitis.Methods From March 2019 to October 2020,children diagnosed of NEC(Bell stage≥II)admitted to the Department of Neonatology of Children’s Hospital of Chongqing Medical University were enrolled in the study.Divided the children into surgical group(n=24)if they perform operation and the intestinal necrosis,otherwise split into medical group(n=25).Collected their clinical data and serum and detected the expression levels of Relmβ,HMGB1,Claudin3,and HBD2 in the serum.T-test,U-test,and Chi-square test were used to compare the two Group serum markers,clinical signs,laboratory test results,abdominal imaging characteristics and other data.Construct ROC curve to analyze the value of serum markers combined with MD7 to predict the timing of NEC surgery.Results There was no significant difference in gestational age,gender,birth weight,age and weight at the time of NEC diagnosed between the two groups of children(P>0.05).As for MD7,there was no significant difference in the positive blood culture,p H,I/T,blood sodium,absolute value of neutropenia,and mean arterial pressure between the two groups(P>0.05),but there was a significant difference in platelet count between the two groups(P<0.05).Comparison of serum markers between the two groups,no significant difference was found in plasma HMGB1,Claudin3,and HBD2(P>0.05),while the plasma Relmβwas significantly different between two groups(P<0.05).ROC curve were used to analyze predicting efficacy of Relmβ,with AUC of 0.662(95%CI 0.518～0.806),sensitivity and specificity were 69.7%and 41.7%.Further more,combined with platelet and Relmβ,AUC increased to 0.734(95%CI 0.600～0.868),and sensitivity and specificity increased to 97.0%and 54.2%.There was no significant difference in gestational age,gender,birth weight,age at the time of NEC diagnosis,and weight between the two groups(P>0.05).The incidence of fixed abdominal tenderness(62.5%vs 12.0%,χ~2=11.4,P=0.001)and abdominal wall swelling(12.5%vs 0,χ~2=4.5,P=0.03)in the surgical group was significantly higher than medical group,the difference was statistically significant(P<0.05).The serum alkaline phosphatase in the surgical group was significantly lower than medical group[(144.0±60.1)U/L vs(194.9±102.0)U/L,t=2.08,P=0.04];the platelet count in the surgical group was significantly lower than medical group[(213.7±105.2)×109/L vs(321.8±130.6)×109/L,t=3.18,P=0.003];the differences were all statistically significant(P<0.05).Comparing the serum markers between the two groups,there was no significant difference in the concentrations of HMGB1,Claudin3,and HBD2(P>0.05).The concentration of Relmβin the surgical group was significantly higher than that in the medical group[20.3(9.0-41.8)umol/L vs 8.9(4.1-19.4)umol/L,Z=2.47,P=0.01],the difference was statistically significant(P<0.05).We give 1 point for abdominal tenderness,redness and swelling of the abdominal wall,and 1 point for Relmβ,platelet count,and serum alkaline phosphatase exceed cut-off value to get a new predict value.Use the predict value to construct the ROC curve,the AUC is 0.899(95%CI:0.805-0.993),P=0.000,when the cut-off value is≥2,the sensitivity is91.7%and the specificity is 84%.Conclusion Relmβcan be combined with MD7 to predict the timing of NEC surgery. |
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