早产儿坏死性小肠结肠炎临床特点及肠道病原学分析

卢燕; 潘珊珊

doi:10.16766/j.cnki.issn.1674-4152.002596

早产儿坏死性小肠结肠炎临床特点及肠道病原学分析

doi: 10.16766/j.cnki.issn.1674-4152.002596

卢燕¹,
潘珊珊^2, ,

1.
浙江大学医学院附属杭州第一人民医院新生儿科，浙江杭州 310006
2.
杭州医学院临床医学系，浙江杭州 310053

基金项目:

浙江省医药卫生科技项目 2021PY057

详细信息

通讯作者:
潘珊珊, E-mail: Pss_2005@163.com

中图分类号: R574.5 R574.62 R722.6
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出版历程
- 收稿日期: 2021-01-17

Analysis of the clinical characteristics and stool pathogen of necrotising enterocolitis in preterm neonates

LU Yan¹,
PAN Shan-shan^{2
, ,}

1.
Department of Neonatology, Affiliated Hangzhou First People' s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China

摘要

摘要: 目的分析早产儿坏死性小肠结肠炎(NEC)的临床特征。方法收集2017年1月—2020年11月在杭州市第一人民医院新生儿科住院符合Bell诊断标准的59例NEC患儿的临床资料并进行回顾性分析。结果 59例NEC患儿中Ⅰ期22例(37.3%)，Ⅱ期或Ⅲ期37例(62.7%)。NEC患儿发病日龄为生后14.0(13.0, 18.0) d，胎龄为(30.7±2.7)周，出生体重为(1 493.9±460.3)g。男36例(61.0%)，女23例(39.0%)。NEC患儿发病后临床表现为血便(79.7%，47/59)、胃内潴留(78.0%、46/59)、肠鸣音减弱(57.6%，34/59)、腹胀(52.5%，31/59)。Ⅱ期及以上NEC患儿腹胀、反应差、肠鸣音减弱、心动过速，CRP≥50 mg/L，白细胞 < 4×10⁹/L发生率更高，差异有统计学意义(均P < 0.05)。大便培养阳性率为65.5%(36/55)，主要包括肺炎克雷伯菌(29.1%，16/55)、屎肠球菌(20.0%，11/55)、大肠埃希菌(12.7%，7/55)。血培养阳性率为15.1%(8/53)，主要包括大肠埃希菌(3.8%，2/53)、肺炎克雷伯菌(3.8%，2/53)。NEC手术治疗比例为20.3%(12/59)，病死率为16.9%(10/59)。结论早产儿NEC以胎龄28~32周，出生体重1 000~1 950 g为主。NEC患儿胃肠道症状突出，NEC Ⅰ期和Ⅱ期或以上患儿临床表现及实验室检查方面均有显著不同。NEC患儿粪便培养阳性率高，肠道致病菌监测有助于指导临床治疗。
- 坏死性小肠结肠炎 /
- 早产儿 /
- 肠道菌群失调
Abstract: Objective To investigate the clinical characteristics of neonatal necrotising enterocolitis (NEC) in preterm infants. Methods A retrospective study was conducted from January 2017 to November 2020 at the Affiliated Hangzhou First People ' s Hospital, Zhejiang University School of Medicine. NEC was defined according to Bell ' s staging criteria. Results Fifty-nine neonates were included in the study. Amongst them, 22 (37.3%) cases developed stage Ⅰ, and 37 cases (62.7%) cases developed stage Ⅱ or Ⅲ. Analysis of the time of NEC onset showed that the median age of NEC onset was 14.0 (13.0, 18.0) day. The gestational age was (30.7±2.7) weeks, and the birth weight was (1 493.9±460.3) g. There were 36 (61.0%) male cases and 23 (39.0%) female cases. The most common clinical presentations were bloody stools (79.7%, 47/59 cases), gastric residuals (78.0%, 46/59), absent bowel sounds (57.6%, 34/59 cases) and abdominal distension (52.5%, 31/59 cases). Compared with the stage Ⅰ group, the stage Ⅱ or Ⅲ group had significantly higher incidence rates of abdominal distension, poor response, absent bowel sound, bradycardia, greater white blood cell count (< 4×10⁹/L) and CRP≥50 mg/L, P < 0.05. The positive rate of stool culture was 65.5% (36/55 cases), mainly including 29.1% Klebsiella pneumoniae (16/55 cases), 20.0% Enterococcus faecium (11/55 cases) and 12.7% Escherichia coli (7/55 cases). The positive rate of blood culture was 15.1% (8/53 cases), including 3.8% Escherichia coli (2/53 cases) and 3.8% Klebsiella pneumoniae (2/53 cases). The incidence of surgical NEC was 20.3% (12/59 cases). The mortality rate of NEC was 16.9% (10/59 cases). Conclusion NEC mainly affects preterm neonates with gestational age of 28-32 weeks and birth weight of 1 000-1 950 g. Gastrointestinal symptoms and signs are prominent. There are significant differences in clinical manifestations and laboratory parameters between neonates in the stage Ⅰ group and those in the stage Ⅱ or Ⅲ group. The positive rate of stool sample culture is high in NEC neonates. Monitoring of intestinal pathogen may be helpful to guide clinical therapy.
- Necrotising enterocolitis /
- Preterm infant /
- Gut dysbiosis
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表 1 不同分期NEC患儿一般情况比较

Table 1. Comparison of general condition of children with NEC at different stages

组别	例数	男/女(例)	胎龄 (x±s，周)	出生体重 (x±s，g)	分娩方式[例(%)]		喂养方式[例(%)]		发病日龄 [(M(P₂₅, P₇₅)，d)]
组别	例数	男/女(例)	胎龄 (x±s，周)	出生体重 (x±s，g)	顺产	剖宫产	母乳	配方奶	发病日龄 [(M(P₂₅, P₇₅)，d)]
Ⅰ期	22	14/8	31.1±3.2	1 522.5±442.2	7(31.8)	15(68.2)	5(22.7)	17(77.3)	14.5(11.5，18.3)
Ⅱ期或Ⅲ期	37	22/15	30.4±2.4	1 476.9±475.9	7(18.9)	30(81.1)	9(24.3)	28(75.7)	14.0(13.0，18.5)
统计量		0.101^a	0.907^b	0.365^b	1.268^a		0.019^a		-0.409^c
P值		0.750	0.368	0.716	0.260		0.889		0.682
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 不同分期NEC患儿临床表现比较[例(%)]

Table 2. Comparison of clinical manifestations in children with different stages of NEC [cases (%)]

组别	例数	腹胀	发热	反应差	胃内潴留	血便	肠鸣音减弱	呼吸暂停	心动过速
Ⅰ期	22	5(22.7)	1(4.5)	4(18.2)	16(72.7)	20(90.9)	6(27.3)	5(22.7)	4(18.2)
Ⅱ期或Ⅲ期	37	26(70.3)	4(10.8)	23(62.2)	30(81.1)	27(73.0)	28(75.7)	13(35.1)	17(45.9)
χ²值		12.506		10.752			13.237	1.002	4.639
P值		< 0.001	0.642^a	0.001	0.524^a	0.179^a	< 0.001	0.317	0.031
注：^a为采用Fisher精确检验。

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表 3 不同分期NEC患儿实验室检查结果比较[例(%)]

Table 3. Comparison of laboratory results in children with different stages of NEC [cases (%)]

组别	例数	CRP(mg/L)		白细胞数(×10⁹/L)		血小板(×10⁹/L)
组别	例数	< 50	≥50	≥4	< 4	≥100	< 100
Ⅰ期	22	17(77.3)	5(22.7)	20(90.9)	2(9.1)	20(90.9)	2(9.1)
Ⅱ期或Ⅲ期	37	11(29.7)	26(70.3)	17(45.9)	20(54.1)	26(70.3)	11(29.7)
χ²值		12.506		11.928		2.325
P值		< 0.001		0.001		0.127

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