新生儿坏死性小肠结肠炎的危险因素

Risk Factors for Neonatal Necrotizing Enterocolitis

摘要: 坏死性小肠结肠炎(NEC)主要见于早产儿，是一种严重危害新生儿生命的疾病，也是NICU最常见的肠道急症。在某些方面，NEC是新生儿学研究成功经验的副产品，其中30~40年前无法存活的低胎龄婴儿现在却可以存活。除了发病率和死亡率极高之外，NEC的长期并发症还包括肠狭窄和粘连、胆汁淤积、短肠综合征、生长迟缓和神经发育迟缓。不幸的是，目前在治疗或预防方面仍没有取得太大进展。在检查文献时，人们可能会认为NEC是一个单一的、同质的疾病，但越来越明确的是，NEC是几种不同表现的疾病或表型。并且，目前对于这种疾病的危险因素及病理生理学仍然知之甚少。NEC的危险因素是多样的，不同危险因素有不同的肠坏死途径。自发性肠穿孔、继发于心脏异常的缺血性肠病以及其他与早产儿最常见的NEC形式。许多观察性研究报告了与NEC相关的临床和非临床风险因素，但在延安地区这些危险因素尚不清楚。为了确定NEC这一复杂疾病的独立风险因素，考虑用多变量分析(最好是前瞻性的)队列设计(包括多个协变量)是比较合适的。本综述描述了一些不同危险的NEC，并对其危险因素进行了一些评估，其中遗传因素、肠不成熟、血流动力学不稳定、炎症和生态失调为本综述主要讨论的NEC的危险因素。

Abstract: Necrotizing enterocolitis (NEC) is the most common intestinal emergency in the NICU. In some ways, NEC is a byproduct of the success of neonatology, in which low-gestational age babies that would not have survived 30 or 40 years ago are now viable. In addition to high morbidity and mortality, long-term complications of NEC include: intestinal stricture and adhesions, cholestasis, short bowel syndrome, growth retardation, and neurodevelopmental delay. Unfortunately, there is still not much progress in treatment or prevention. In examining the literature, one might think that NEC is a single, homogenous disease, but it is increasingly clear that NEC is a disease or phenotype with several different manifestations. In addition, the risk factors and pathophysiology of this disease are still poorly understood. Risk factors for NEC are varied, and different risk factors have different pathways of intestinal necrosis. Spontaneous intestinal perforation, ischemic bowel disease sec-ondary to cardiac abnormalities, and other forms of NEC are most commonly associated with prem-ature infants. Many observational studies have reported clinical and non-clinical risk factors associ-ated with NEC, but these written risk factors remain unclear in Yan’an. To determine independent risk factors for this complex disease, it is appropriate to consider a multivariable analysis (prefera-bly prospective) cohort design that includes multiple covariables. This review describes a number of different risk factors for NEC and provides an assessment of their risk factors, among which ge-netic factors, intestinal immaturity, hemodynamic instability, inflammation and ecological disor-ders are discussed.