Early Detection of Impending Necrotizing Enterocolitis with Urinary Intestinal Fatty Acid-Binding Protein
Early Detection of Impending Necrotizing Enterocolitis with Urinary Intestinal Fatty Acid-Binding Protein
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DOI：
10.1159/000362497
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发表时间：
2014-01-01
期刊：
影响因子：
2.5
通讯作者：
Angeles, Danilyn
中科院分区：
文献类型：
--
作者：
Gollin, Gerald;Stadie, Derek;Angeles, Danilyn
工作背景：坏死性小肠结肠炎（NEC）的诊断后，喂养不耐受和特征性的身体和影像学表现的发展。亚临床前驱症状的早期检测可能有助于制定预防或减轻疾病严重程度的措施。目的：我们试图确定尿肠脂肪酸结合蛋白（iFABP（u））是否可能在NEC首次临床表现之前升高。方法：收集62例胎龄24-28周的新生儿的尿液。根据临床、影像学和手术结果，确定受试者患有Bell 2期或3期NEC。在所有NEC受试者和21名年龄匹配的对照者中，使用ELISA测定iFABP（u），并以其与尿肌酐（Cr）的比值表示，即iFABP（u）/Cr-u。构建受试者工作特征（ROC）曲线，以确定iFABP（u）/Cr-u对首次临床表现前几天即将发生NEC的预测值。结果：5例受试者发生NEC（2期：n = 3，3期：n = 2）。在NEC首次临床表现的前一天，ROC曲线显示iFABP（u）/Cr-u > 10.2pg/nmol预测即将发生NEC的敏感性为100%，特异性为95.6%。iFABP（u）/Cr-u不能预测疾病首次出现体征前2天的NEC。结论：iFABP（u）升高是NEC首次临床表现前1天即将发生的敏感和特异性预测因子。iFABP（u）筛查可能会发现高危婴儿，并允许采取措施改善或预防NEC。(C)2014 S. Karger AG，巴塞尔
Background: Necrotizing enterocolitis (NEC) is diagnosed after the development of feeding intolerance and characteristic physical and imaging findings. Earlier detection of a subclinical prodrome might allow for the institution of measures that could prevent or attenuate the severity of the disease. Objectives: We sought to determine whether urinary intestinal fatty acid-binding protein (iFABP(u)) might be elevated prior to the first clinical manifestations of NEC. Methods: Urine was collected daily from 62 infants of a gestational age of 24-28 weeks. Based on clinical, imaging and operative findings, subjects were determined to have Bell stage 2 or 3 NEC. In all the subjects with NEC and in 21 age-matched controls, iFABP(u) was determined using an ELISA, and was expressed in terms of its ratio to urinary creatinine (Cr), i.e. iFABP(u)/Cr-u. Receiver operating characteristic (ROC) curves were constructed to define the predictive value of iFABP(u)/Cr-u for impending NEC in the days prior to the first clinical manifestations. Results: Five subjects developed NEC (stage 2: n = 3 and stage 3: n = 2). The day before the first clinical manifestation of NEC, a ROC curve showed that an iFABP(u)/Cr-u > 10.2 pg/nmol predicted impending NEC with a sensitivity of 100% and a specificity of 95.6%. iFABP(u)/Cr-u did not predict NEC 2 days prior to the first sign of disease. Conclusions: An elevated iFABP(u) was a sensitive and specific predictor of impending NEC 1 day prior to the first clinical manifestations. iFABP(u) screening might identify infants at a high risk and allow for the institution of measures that could ameliorate or prevent NEC. (C) 2014 S. Karger AG, Basel