解脲脲原体感染新生儿血常规、D-二聚体及降钙素原水平与坏死性小肠结肠炎的关系研究

Study on the relationship between blood routine, D-dimer, and procalcitonin levels in Ureaplasma urealyticum-infected neonates and the development of necrotizing enterocolitis

摘要:

目的 探讨解脲脲原体感染新生儿血常规、D-二聚体（D-D）和降钙素原（PCT）水平与坏死性小肠结肠炎（NEC）的关系，为NEC的早期识别、诊断和治疗提供参考。方法 选取2021年1月—2023年12月厦门大学附属中山医院收治的86例解脲脲原体感染的新生儿。根据是否发展为NEC，分为NEC组29例和非NEC组57例。比较两组患儿的血常规［平均血小板体积（MPV）、白细胞计数（WBC）、中性粒细胞数（NEUT）］、D-D和PCT水平；采用多因素一般Logistic回归分析解脲脲原体感染新生儿继发NEC的影响因素；构建NEC预测列线图模型，分析预测效能；绘制受试者工作特征（ROC）曲线分析诊断效能。结果 NEC组与非NEC组的性别构成、生产方式构成比、胎膜早破构成比、先天性心脏病构成比，母亲年龄、妊娠糖尿病构成比、妊娠高血压构成比、孕期使用激素构成比比较，差异均无统计学意义（P >0.05）；NEC组胎龄小于非NEC组（P <0.05），出生体重低于非NEC组（P <0.05），晚发性羊水过少构成比高于非NEC组（P <0.05）。NEC组D-D、PCT、MPV和WBC水平均高于非NEC组（P <0.05）。多因素一般Logistic回归分析结果显示，胎龄［O^R =0.547（95% CI：0.309，0.970）］、出生体重［O^R =0.140（95% CI：0.029，0.689）］是感染患儿继发NEC的保护因素（P <0.05）；晚发性羊水过少［O^R =132.685（95% CI：2.025，8 694.860）］、D-D水平高［O^R =1.085（95% CI：1.024，1.149）］、PCT水平高［O^R =732.105（95% CI：11.495，46 627.057）］、MPV水平高［O^R=1.699（95% CI：1.118，2.581）］和WBC水平高［O^R =1.683（95% CI：1.084，2.614）］是解脲脲原体感染患儿继发NEC的危险因素（P <0.05）。列线图模型显示，解脲脲原体感染新生儿胎龄较小、出生体重较轻、晚发性羊水过少、D-D、PCT、MPV和WBC水平较高，继发NEC的风险更高。ROC曲线分析结果显示，D-D、PCT、MPV、WBC联合检测的曲线下面积为0.982（95% CI：0.960，1.000），敏感性为93.10%（95% CI：0.772，0.992），特异性为98.20%（95% CI：0.906，1.000），联合检测具有更高的诊断效能。结论 解脲脲原体感染新生儿血常规、D-D和PCT水平的异常变化与NEC发展有关，这为NEC的早期诊断和治疗提供了参考依据。

Abstract:

Objective To explore the relationship between blood routine parameters, D-dimer (D-D), and procalcitonin (PCT) levels in neonates infected with Ureaplasma urealyticum and the development of necrotizing enterocolitis (NEC). This study aims to provide references for the early identification, diagnosis, and treatment of NEC.Methods Eighty-six neonates infected with Ureaplasma urealyticum, admitted to Zhongshan Hospital, Xiamen University from January 2021 to December 2023, were included in this study. The neonates were divided into two groups: the NEC group (29 cases) and the non-NEC group (57 cases). Blood routine parameters [mean platelet volume (MPV), white blood cell count (WBC), and neutrophil count (NEUT)], D-D, and PCT levels were compared between the two groups. Multivariate logistic regression analysis was used to identify risk factors for NEC in these neonates. A nomogram was constructed to predict NEC risk, and its predictive efficacy was analyzed using a receiver operator characteristic (ROC) curve.Results No significant differences were observed between the NEC and non-NEC groups regarding gender composition, mode of delivery, incidence of premature rupture of membranes, congenital heart disease, maternal age, incidence of gestational diabetes, gestational hypertension, and steroid use during pregnancy (P > 0.05). However, the NEC group had a significantly lower gestational age (P < 0.05), lower birth weight (P < 0.05), and a higher incidence of late-onset oligohydramnios compared to the non-NEC group (P < 0.05). The NEC group also exhibited significantly higher levels of D-D, PCT, MPV, and WBC (P < 0.05). Multivariate logistic regression analysis identified gestational age [O^R = 0.547 (95% CI: 0.309, 0.970)] and birth weight [O^R = 0.140 (95% CI: 0.029, 0.689)] as protective factors against NEC (P < 0.05). In contrast, late-onset oligohydramnios [O^R = 132.685 (95% CI: 2.025, 8 694.860)], elevated D-D levels [O^R = 1.085 (95% CI: 1.024, 1.149)], elevated PCT levels [O^R = 732.105 (95% CI: 11.495, 46 627.057)], increased MPV [O^R = 1.699 (95% CI: 1.118, 2.581)], and elevated WBC [O^R = 1.683 (95% CI: 1.084, 2.614)] were identified as risk factors for NEC (P < 0.05). The nomogram model indicated that neonates with smaller gestational age, lower birth weight, late-onset oligohydramnios, elevated D-D, PCT, MPV, and WBC levels were at higher risk of developing NEC. The ROC curve analysis demonstrated that the combined detection of D-D, PCT, MPV, and WBC levels had an area under the curve (AUC) of 0.982 (95% CI: 0.960, 1.000), with a sensitivity of 93.10% (95% CI: 0.772, 0.992) and a specificity of 98.20% (95% CI: 0.906, 1.000), indicating high diagnostic efficacy.Conclusion Abnormal changes in blood routine parameters, D-D, and PCT levels in Ureaplasma urealyticum-infected neonates are associated with the development of NEC. These findings provide a reference for the early diagnosis and treatment of NEC.