New insights into spontaneous intestinal perforation using a national data set: (2) two populations of patients with perforations
New insights into spontaneous intestinal perforation using a national data set: (2) two populations of patients with perforations
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DOI：
10.1038/sj.jp.7211439
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发表时间：
2006-03-01
影响因子：
2.9
通讯作者：
Gordon, P. V.
中科院分区：
文献类型：
--
作者：
Attridge, J. T.;Clark, R.;Gordon, P. V.
背景：自发性肠穿孔（SIP）在早产儿中越来越常见，并已被证明与产后早期使用糖皮质激素和吲哚美辛有关。在极低出生体重 (ELBW) 婴儿存活之前，SIP 被认为是一种罕见的先天性疾病，偶发性影响远端肠道肌层。这些对病因学的不同观点之前在文献中尚未得到调和。 目标：(1) 在国家数据集中建立一组 SIP 患者。 (2) 使用诊断时间作为独特的数据元素，从而区分易受产后危险因素影响的 SIP 病例与出生时或出生后立即发生的病例（因此不会暴露于产后危险因素）。方法：使用大型去识别的国家数据集回顾性观察诊断时间，然后将队列分为产后治疗组以进行进一步的亚分析。该分析将队列分为早期和晚期诊断 SIP 亚队列。然后通过单变量分析对这些数据进行回顾性查询，以寻找两者之间的人口统计学差异（使用 P 值 < 0.05）。结果：此数据集中评估了 633 名 SIP 患者。早期 SIP 队列（0 - 3 天）由 116 名婴儿组成，中位体重为 1.401 kg，而晚期队列（4 - 14 天）由 386 名婴儿组成，中位体重为 775 g。患有早期 SIP 的婴儿明显更有可能：为男性、具有较高的 Apgar 评分、未接受产前类固醇、表面活性剂或需要的机械通气。 结论： 两类婴儿获得 SIP：ELBW 婴儿在接触吲哚美辛和糖皮质激素（内源性或外源性）后平均在出生后 7 至 10 天获得 SIP，而患有早期 SIP（0 - 3 天）的婴儿则明显更容易发生 SIP。接触产后危险因素的可能性较小，早产的可能性较小。
Background: Spontaneous intestinal perforation ( SIP) is increasingly common in the premature infant and has been demonstrated to be associated with early postnatal administration of glucocorticoids and indomethacin. Before survival of the extremely low birth weight (ELBW) infant, SIP was thought to be a rare, congenitally acquired disease sporadically affecting the muscularis of the distal intestine. These disparate views of etiology have not been previously reconciled in the literature.Objectives: ( 1) To establish a cohort of SIP patients in a national data set. ( 2) To use timing of diagnosis as a unique data element and thereby differentiate between SIP cases which are susceptible to postnatal risk factors versus those occurring at or immediately after birth ( and therefore not exposed to postnatal risk factors).Methods: A large deidentified national data set was used to retrospectively look at timing of diagnosis and then the cohort was divided into postnatal treatment groups for further subanalyses. This analysis resulted in the division of the cohort into early and late diagnosis SIP subcohorts. These were then queried retrospectively by univariate analysis to look for differences in demographics between the two ( using a P-value < 0.05)Results: There were 633 patients with SIP evaluated in this data set. The early SIP cohort ( 0 - 3 days) was made up of 116 infants with a median BW of 1.401 kg, whereas the late cohort ( 4 - 14 days) held 386 infants with a median BW of 775 g. Infants with early SIP were significantly more likely to: be male, have higher Apgar scores, have not received antenatal steroids, surfactant or required mechanical ventilation.Conclusions: Two populations of infants acquire SIP: ELBW infants acquire SIP on average between 7 and 10 days of life after exposure to indomethacin and glucocorticoids ( either endogenous or exogenous), and infants with early SIP ( 0 - 3 days) who are significantly less likely to have been exposed to postnatal risk factors and are less premature.