Relationship between plasma D-lactate levels and prognosis of neonatal necrotizing enterocolitis

( views:192, downloads:0 )
Author:
CHEN Dong-mei(Department of Neonatal Intensive Care Unit, Quanzhou Children's Hospital, Fujian Province ,Quanzhou 362000,China)
LEI Guo-feng(Department of Neonatal Intensive Care Unit, Quanzhou Children's Hospital, Fujian Province ,Quanzhou 362000,China)
PENG Wei-lin(Department of Neonatal Intensive Care Unit, Quanzhou Children's Hospital, Fujian Province ,Quanzhou 362000,China)
Journal Title:
Chinese Journal of Perinatal Medicine
Issue:
Volume 14, Issue 10, 2011
DOI:
10.3760/cma.j.issn.1007-9408.2011.10.002
Key Word:
Enterocolitis, necrotizing;Lactic acid;Infant, newborn;Prognosis

Abstract: Objective To investigate the relationship between plasma D-lactate levels and prognosis in newborns with neonatal necrotizing enterocolitis (NEC).Methods One hundred and four premature infants with NEC (stase Ⅱ and Ⅲ ) and another 104 premature infants without NEC admitted into Quanzhou Children's Hospital for other diseases from January 2007 to October 2010 were selected into this case control study.The gestational age,gender and birth weight of patients in the two groups were matched.NEC patients' bloods were collected within 24 hours after NEC was confirmed and blood samples of the control group were collected at the corresponding age.Enzymelinked immunosorbent assay was used to detect the plasma D-lactate level.Receiver operating characteristic curve was used to confirm the criteria of D-lactate positive,according to which,the NEC group was divided into high D-lactate group and normal D-lactate group,and the mortality and complication rate of the two groups were compared with x2 test.And NEC group was subdivided into death group and survive group according to the prognosis of the patients,and the difference of D-lactate level between the two groups were compared with t test.Results Among the NEC group,there were 63 cases (60.6%) of stage Ⅱ and 41 (39.4%) cases of stage Ⅲ ; 88 (84.6%) survived infants and 16 (15.4%) dead infants.D-lactate level was (35.4 ± 29.1) μg /ml in stage Ⅲ NEC group,(29.5±16.2) μg/ml in stage Ⅱ NEC group and (3.7±18.4) μg/ml in control group; there were statistical differences between each other(F=5.97,P<0.05).Receiver operating characteristic curve analysis showed that if 6 μg/ml was set as the borderline,there were 87 cases(83.7%,87/104) with high D-lactate patients in NEC group,whose neonatal critical illness scoring (NCIS) was 80.9±22.6,significantly lower than that of normal D-lactate patients ( 95.8 ± 20.5) (t =2.417,P< 0.05),and higher neonatal septicemia rate (48.3%,42/87) and mortality (27.6%,24/87) compared with those [(5.9%,1/17) and (5.9%,1/17)] of normal D-lactate patients(x2 =11.539 and 7.146,P<0.05,respectively).In NEC group,compared with the survived infants,the D-lactate level [(43.2±13.5) μg/ml vs (21.9 ± 22.9) μg/ml,t =4.572,P<0.05] and the rate of septicemia [68.8% (11/16) vs 38.6% (34/88),x2 =3.445,P<0.05] were higher in dead patients,and NCIS (82.4± 29.1 vs 90.6 ± 21.3,t =2.409,P<0.05) was lower.Conctusions The level of plasma D-lactate related to the prognosis of neonatal NEC and which might be a good indicator for its prognosis and severity.

  • [1]李德渊,李晋辉,母得志.新生儿坏死性小肠结肠炎研究进展.四川医学,2007,28:481-482.
  • [2]Yost CC.Neonatal necrotizing enteroeolitis:diagnosis,management,and pathogenesis.J Infus Nurs,2005,28:130-134.
  • [3]李文毅,金毕,谷涌泉,等.D-乳酸、乳酸脱氢酶、血红蛋白在急性肠缺血早期诊断中的作用.中华医学杂志,2005,29:453-454.
  • [4]刘牧林,张嘉,刘瑞林,等.肠脂肪酸结合蛋白和D-乳酸早期诊断肠缺血-再灌注损害的实验研究.中华创伤杂志,2006,22:767-770.
  • [5]金汉珍,黄德珉,官希吉.实用新生儿学.3版.北京:人民卫生出版社,2003:509.
  • [6]中华医学会急诊学分会儿科学组.新生儿危重病例评分法(草案).中华儿科杂志,2001,39:42.
  • [7]Dimmit RA,Glew R,Colby C,et al.Serum cytosolie-glueosidase activity in a rat model of neerotizing enterocolitis.Pediatr Res,2003,54:462-465.
  • [8]阴怀清,石岩,王阿琚,等.降钙素基因相关肽在新生儿坏死性小肠结肠炎发病机理中作用的实验研究.中华围产医学杂志,2003,6:168-171.
  • [9]Bell MJ,Ternberg JL,Feigin RD,et al.Neonatal necrotizing enterocolitis.Therapeutic decisions based upon clinicial staging.Ann Surg,1978,187:1-7.
  • [10]Evennett NJ,Hall NJ,Pierro A,et al.Urinary intestinal fatty acid-binding protein concentration predicts extent of disease in necrotizing enterocolitis.J Pediatr Surg,2010,45:735-740.
  • [11]姚咏明,盛志勇,吴叶,等.大鼠急性肠缺血后血浆D-乳酸的变化及肠粘膜损害的关系.中华整形烧伤外科杂志,1998,14:266-269.
  • [12]Caglayan F,Cakmak M,Caglayan O,et al.Plasma D-lactate levels in diagnosis of appendicitis.J Invest Surg,2003,16:233-237.
  • [13]Demircan M,Cetin S,Uguralp S,et al.Plasma D-lactate level:a useful marker to distinguish a erforared appendix from acute simple appendicitis.Asian J Surg,2004,27:303-305.
  • [14]Pelsers MM,Hermens WT,Glatz JF.Fatty acid-binding proteins as plasma markers of tissue injury.Clin Chim Acts,2005,352:15-35.
  • [15]Brown RE,Rimsza LM,Pastos K,et al.Effects of sepsis on neonatal thrombopoiesis.Pediat r Res,2008,64:399-404.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn