Application of fecal calprotectin in diagnosing necrotizing enterocolitis of very low birth weight infants

doi:10.3877/cma.j.issn.1673-5250.2015.03.015

Objective

To explore the diagnostic value of neutrophil-derived fecal marker fecal calprotectin (FC) in diagnosing necrotizing enterocolitis (NEC) for very low birth weight (VLBW) infants.

Methods

A total of 35 cases of VLBW infants with NEC symptoms who were gathered from Changzhou Children's Hospital and Changzhou Maternal and Child Health Care Hospital between July 2011 to June 2013 were selected as NEC group. NEC group were further divided into diagnosed NEC sub-group (n=15) and suspected NEC sub-group (n=20). Meanwhile, 30 VLBW infants with feeding intolerance were selected into feeding intolerance group (n=30), and 30 VLBW infants with normal milk-feeding and no gastrointestinal symptoms were selected into control group(n=30). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Changzhou Children's Hospital and Changzhou Maternal and Child Health Care Hospital. Informed consent was obtained from the parents of each participating child. The FC levels and occult blood (OB) were detected among different groups. And the FC levels and positive detection rates of OB among 4 groups were compared.

Results

The FC levels in the early stage and critical stage of diagnosed NEC sub-group were higher than that of control group (t=6.62, 8.44; P<0.05), and there was significant difference in the aspect of FC levels among early stages, critical stage and recovery stage in diagnosed group (F=9.563, P<0.05). There was no significant difference in the aspect of FC levels between feeding intolerance group and control group (t=0.64, P>0.05). Furthermore, there was significant difference in the aspect of positive detection rate of OB between critical stage in diagnosed NEC sub-group and control group (χ²=15.469, P<0.05), but there were no significant differences between early stage in diagnosed NEC sub-group and control group, recovery stage in diagnosed NEC sub-group and control group (χ²=0.703, 0.000; P>0.05). But there were no significant differences between suspected stage in suspected NEC sub-group and control group, recovery stage in suspected NEC sub-group and control group, feeding intolerance group and control group (χ²=2.000, 0.000, 0.185; P>0.05).

Conclusions

Compared with fecal OB test, the examination of FC was more sensitive in diagnosing early-stage NEC. FC level can be considered as an effective index to diagnose and evaluate VLBW infants combined with NEC. It can also be used to distinguish NEC and feeding intolerance.

Key words: Infant, very low birth weight, Enterocolitis, necrotizing, Fecal calprotectin, Infant, newborn

表1 4组患儿一般临床病历资料比较(±s)

Table 1 Comparison of general data among four groups (±s)

组别		例数	性别[例数(%)]		胎龄(孕周)	出生体质量(g)
组别		例数	男性	女性	胎龄(孕周)	出生体质量(g)
NEC组		?	?	?	?	?
?	确诊NEC亚组	15	9(60.0)	6(40.0)	31.1±2.7	1 280±210
?	疑似NEC亚组	20	12(60.0)	8(40.0)	30.9±2.9	1 260±220
喂养不耐受组		30	19(63.3)	11(36.7)	31.9±2.3	1 240±190
对照组		30	17(56.7)	13(43.3)	31.5±2.9	1 280±210
F值/χ²值			0.198		1.212	1.065
P值		?	0.906		0.369	0.421

表1 4组患儿一般临床病历资料比较(±s)

Table 1 Comparison of general data among four groups (±s)

组别		例数	性别[例数(%)]		胎龄(孕周)	出生体质量(g)
组别		例数	男性	女性	胎龄(孕周)	出生体质量(g)
NEC组		?	?	?	?	?
?	确诊NEC亚组	15	9(60.0)	6(40.0)	31.1±2.7	1 280±210
?	疑似NEC亚组	20	12(60.0)	8(40.0)	30.9±2.9	1 260±220
喂养不耐受组		30	19(63.3)	11(36.7)	31.9±2.3	1 240±190
对照组		30	17(56.7)	13(43.3)	31.5±2.9	1 280±210
F值/χ²值			0.198		1.212	1.065
P值		?	0.906		0.369	0.421

表2 4组患儿粪便钙卫蛋白水平及大便隐血结果比较(±s)

Table 1 Comparison of FC levels and positive rates of OB among different groups(±s)

组别			例数	FC(pg/mL)	OB阳性检出率[例数(%)]
NEC组			?	?	?
?	确诊NEC亚组		15	?	?
?	?	早期	?	53.66±11.86	3(20.0)
?	?	极期	?	79.41±20.17	10(66.7)
?	?	恢复期	?	31.44± 7.69	1 (6.7)
?	?	F值/χ²值	?	9.563	13.894
?	?	P值	?	<0.05	<0.05
?	疑似NEC亚组		20	?	?
?	?	疑似期	?	50.27±10.29	5(25.0)
?	?	恢复期	?	32.86± 7.01	2(10.0)
?	?	t值/χ²值	?	5.342	1.558
?	?	P值	?	<0.05	>0.05
喂养不耐受组			30	35.16±10.07	4(13.3)
对照组			30	33.64± 8.20	2 (6.7)

表2 4组患儿粪便钙卫蛋白水平及大便隐血结果比较(±s)

Table 1 Comparison of FC levels and positive rates of OB among different groups(±s)

组别			例数	FC(pg/mL)	OB阳性检出率[例数(%)]
NEC组			?	?	?
?	确诊NEC亚组		15	?	?
?	?	早期	?	53.66±11.86	3(20.0)
?	?	极期	?	79.41±20.17	10(66.7)
?	?	恢复期	?	31.44± 7.69	1 (6.7)
?	?	F值/χ²值	?	9.563	13.894
?	?	P值	?	<0.05	<0.05
?	疑似NEC亚组		20	?	?
?	?	疑似期	?	50.27±10.29	5(25.0)
?	?	恢复期	?	32.86± 7.01	2(10.0)
?	?	t值/χ²值	?	5.342	1.558
?	?	P值	?	<0.05	>0.05
喂养不耐受组			30	35.16±10.07	4(13.3)
对照组			30	33.64± 8.20	2 (6.7)

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