Urinary Intestinal Fatty Acid-Binding Protein Can Distinguish Necrotizing Enterocolitis from Sepsis in Early Stage of the Disease.
Urinary Intestinal Fatty Acid-Binding Protein Can Distinguish Necrotizing Enterocolitis from Sepsis in Early Stage of the Disease.
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DOI：
10.1155/2016/5727312
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发表时间：
2016
影响因子：
4.1
通讯作者：
Kverka M
中科院分区：
文献类型：
--
作者：
Coufal S;Kokesova A;Tlaskalova-Hogenova H;Snajdauf J;Rygl M;Kverka M
坏死性小肠结肠炎（NEC）是一种严重的胃肠道疾病，但其早期症状无特异性，易与败血症互换。因此，在临床实践中需要用于早期诊断的可靠生物标志物。在这里，我们分析了肠粘膜损伤的标志物，半胱天冬酶裂解的细胞角蛋白18（ccCK 18）和肠脂肪酸结合蛋白（I-FABP），可用于鉴别诊断NEC在疾病的早期阶段。我们收集配对血清（在登记和一周后）和尿液（收集两天，6小时的间隔）样本从42例疑似NEC。这些患者随后使用标准标准分为NEC组（n = 24）和败血症组（n = 18），NEC组包括13例胃肠道手术后患者。健康婴儿（n = 12），没有任何以前的肠道手术，作为对照。两种生物标志物均通过商业ELISA测定法测量。NEC和脓毒症之间的血清ccCK 18无统计学显著差异，但NEC患者的血清和尿I-FABP水平显著高于脓毒症患者或健康婴儿。尿I-FABP具有较高的敏感性（81%）和特异性（100%），甚至可以区分手术后患者的NEC和脓毒症。尿I-FABP可较腹部X线更好地鉴别NEC与新生儿败血症，包括术后败血症。
Necrotizing enterocolitis (NEC) is severe disease of gastrointestinal tract, yet its early symptoms are nonspecific, easily interchangeable with sepsis. Therefore, reliable biomarkers for early diagnostics are needed in clinical practice. Here, we analyzed if markers of gut mucosa damage, caspase cleaved cytokeratin 18 (ccCK18) and intestinal fatty acid-binding protein (I-FABP), could be used for differential diagnostics of NEC at early stage of disease. We collected paired serum (at enrollment and week later) and urine (collected for two days in 6 h intervals) samples from 42 patients with suspected NEC. These patients were later divided into NEC (n = 24), including 13 after gastrointestinal surgery, and sepsis (n = 18) groups using standard criteria. Healthy infants (n = 12), without any previous gut surgery, served as controls. Both biomarkers were measured by a commercial ELISA assay. There were no statistically significant differences in serum ccCK18 between NEC and sepsis but NEC patients had significantly higher levels of serum and urinary I-FABP than either sepsis patients or healthy infants. Urinary I-FABP has high sensitivity (81%) and specificity (100%) and can even distinguish NEC from sepsis in patients after surgery. Urinary I-FABP can be used to distinguish NEC from neonatal sepsis, including postoperative one, better than abdominal X-ray.