肠腹壁造口对新生儿坏死性小肠结肠炎免疫指标和感染指标的影响

doi:10.20223/j.cnki.1000-8535.2025.11.010

广州医药 ›› 2025, Vol. 56 ›› Issue (11): 1542-1548.DOI: 10.20223/j.cnki.1000-8535.2025.11.010

肠腹壁造口对新生儿坏死性小肠结肠炎免疫指标和感染指标的影响

陈世凯¹, 郭婷婷¹, 范琳琳², 姚浙江¹, 张玉海¹, 张建军¹

1 潍坊市妇幼保健院小儿外科（山东潍坊 261000）
2 高密市人民医院健康管理中心（山东高密 261500）

收稿日期:2024-10-08 出版日期:2025-11-20 发布日期:2025-12-25
通讯作者: 张建军,E-mail：969490919@qq.com
基金资助:
潍坊市科技发展计划项目（2021YX049）

Effect of enterostomy on immune indexes and infection indexes in necrotizing enterocolitis

CHEN Shikai¹, GUO Tingting¹, FAN Linlin², YAO Zhejiang¹, ZHANG Yuhai¹, ZHANG Jianjun¹

1 Department of Pediatric Surgery,Weifang Maternal and Child Health Hospital,Weifang 261000,China
2 Health Management Centre,Gaomi People’s Hospital,Gaomi 261500,China

Received:2024-10-08 Online:2025-11-20 Published:2025-12-25

摘要/Abstract

摘要： 目的探究新生儿坏死性小肠结肠炎接受肠腹壁造口术后,对感染指标和免疫指标的影响效果,以及术中、术后不良反应发生情况。方法选取2016年1月—2024年1月因坏死性小肠结肠炎在潍坊市妇幼保健院接受肠腹壁造口术的56例患儿为A组,另收集同时期因坏死性小肠结肠炎行I期肠切除肠吻合的39例患儿为B组,观察并比较两组患儿术前、术后免疫指标和感染指标的变化情况。另收集同时期40名健康新生儿,对比A组患儿出院前的免疫、感染指标的与健康新生儿差异情况。出院后继续门诊随访,观察术后并发症及不良反应发生情况。结果 A组和B组患儿接受手术后,免疫指标（IgA、IgG、IgM）较术前呈上升趋势,而感染指标（IL-6、PCT、TNF-α）较术前下降。出院前1天A组IgG、IgM水平均高于B组,差异有统计学意义（t=2.312,P=0.023;t=3.214,P=0.002）。B组患儿术后第2天、术后第7天、出院前1天IL-6水平高于A组,差异有统计学意义（t=-4.252,P<0.001;t=-3.383,P=0.001;t=-2.505,P=0.014）。至出院前1天,A组患儿的免疫指标和感染指标与健康新生儿相比,差异无统计学意义（P<0.05）。所有手术患儿住院期间至还纳手术前无严重并发症发生。结论肠腹壁造口术对患有坏死性小肠结肠炎的患儿治疗效果较好,可在一定程度上减轻炎症反应,改善患儿免疫功能。远期效果较好,安全性良好。

关键词: 肠腹壁造口, 坏死性小肠结肠炎, 炎症水平, 免疫指标

Abstract: Objective To investigate the effect of enterostomy on infection indexes and immune indexes in necrotizing enterocolitis,as well as the occurrence of enterostomy and postoperative adverse reactions．Methods Fifty-six neonates who underwent enterostomy for necrotizing enterocolitis in Weifang Maternal and Child Health Hospital from January 2016 to January 2024 were selected as Group A,and 39 neonates who underwent phase I intestinal resection and anastomosis for necrotizing enterocolitis during the same period were selected as Group B．The changes of preoperative and postoperative immune indicators and infection indicators between the two groups of neonates were observed and compared．In addition,40 healthy neonates were selected during the same period,and the differences in immune and infection indexes between group A and healthy neonates were compared before discharge．Patients were followed up after discharge to observe postoperative complications and adverse reactions．Results After surgery,the immune indexes（IgA,IgG,IgM）of the two groups（A and B） were higher than those before surgery,while the infection indexes（IL-6,PCT,TNF-α）were significantly lower than those before surgery．The levels of IgG and IgM in Group A were higher than those in Group B one day before discharge,and the differences were statistically significant（t=2.312,P=0.023;t=3.214,P=0.002）．In Group B,the levels of IL-6 on postoperative day two,postoperative day seven,and one day before discharge were significantly higher than in Group A．The differences were statistically significant（t=-4.252,P<0.001;t=-3.383,P=0.001;t=-2.505,P=0.014）．By one day before discharge,the immune indicators and infection indicators of the infants in Group A were not significantly different from those of healthy newborns．No serious complications occurred among all surgical patients during their hospital stay until the enterostomy closure．Conclusions Enterostomy has a good therapeutic effect on neonates with necrotizing enterocolitis,which can reduce the inflammatory response and improve the immune function of children to a certain exten,with better long-term effects and good safety．

Key words: enterostomy, necrotizing enterocolitis, levels of inflammation, immune indexes

陈世凯, 郭婷婷, 范琳琳, 姚浙江, 张玉海, 张建军. 肠腹壁造口对新生儿坏死性小肠结肠炎免疫指标和感染指标的影响[J]. 广州医药, 2025, 56(11): 1542-1548.

CHEN Shikai, GUO Tingting, FAN Linlin, YAO Zhejiang, ZHANG Yuhai, ZHANG Jianjun. Effect of enterostomy on immune indexes and infection indexes in necrotizing enterocolitis[J]. Guangzhou Medical Journal, 2025, 56(11): 1542-1548.

参考文献

[1] 汪健. 新生儿坏死性小肠结肠炎研究新进展[J].临床小儿外科杂志,2022,21(4):301-305.
[2] ROBERTS A G,YOUNGE N,GREENBERG R G.Neonatal necrotizing enterocolitis:An update on pathophysiology,treatment,and prevention[J].Paediatr Drugs,2024,26(3):259-275.
[3] 陈玄玄,陈琦,曹振杰,等.新生儿坏死性小肠结肠炎所致回肠穿孔不同手术方式对血清学标志物的影响[J].中国实用医刊,2018,45(8):8-11.
[4] 中华医学会小儿外科分会新生儿外科学组.新生儿坏死性小肠结肠炎外科手术治疗专家共识[J].中华小儿外科杂志,2016,37(10):724-728.
[5] 韩金宝,余梦楠,刘钢,等.新生儿坏死性小肠结肠炎肠穿孔与肠未穿孔患儿术后结局的对比研究[J].临床小儿外科杂志,2022,21(6):530-534.
[6] GOLDFARB M,CHOI P M,GOLLIN G.Primary anastomosis versus stoma for surgical necrotizing enterocolitis in US children’s hospitals[J].J Surg Res,2024(295):296-301.
[7] 中国医师协会新生儿科医师分会循证专业委员会.新生儿坏死性小肠结肠炎临床诊疗指南(2020)[J].中国当代儿科杂志,2021,23(1):1-11.
[8] 张志波. 新生儿坏死性小肠结肠炎:从Bell分期解读到手术指征的把握[J].临床小儿外科杂志,2022,21(4):306-309.
[9] FLAHIVE C,SCHLEGEL A,MEZOFF E A.Necrotizing enterocolitis:Updates on morbidity and mortality outcomes[J].J Pediatr,2020(220):7-9.
[10] CAO X,ZHANG L,JIANG S,et al.Epidemiology of necrotizing enterocolitis in preterm infants in China:A multicenter cohort study from 2015 to 2018[J].J Pediatr Surg,2022,57(3):382-386.
[11] DUESS J W,SAMPAH M E,LOPEZ C M,et al.Necrotizing enterocolitis,gut microbes,and sepsis[J].Gut Microbes,2023,15(1):2221470.
[12] MEISTER A L,DOHENY K K,TRAVAGLI R A.Necrotizing enterocolitis:It’s not all in the gut[J].Exp Biol Med(Maywood),2020,245(2):85-95.
[13] NEU J.Necrotizing Enterocolitis:The future[J].Neonatology,2020,117(2):240-244.
[14] BüTTER A,FLAGEOLE H,LABERGE J M.The changing face of surgical indications for necrotizing enterocolitis[J].J Pediatr Surg,2002,37(3):496-499.
[15] POKORNY W J,GARCIA-PRATS J A,BARRY Y N.Necrotizing enterocolitis:Incidence,operative care,and outcome[J].J Pediatr Surg,1986,21(12):1149-1154.
[16] 吴书清,钟斌,刘辉,等.Bishop-Koop造瘘术和双口造瘘术在新生儿坏死性小肠结肠炎中的疗效比较[J].临床小儿外科杂志,2018,17(11):835-839.
[17] SILVA M,MIRANDA M L,OLIVEIRA-FILHO A G,et al.Bishop-koop ostomy revisited:A “test-drive” intestinal diversion for children with suspected bowel dysmotility[J].Arq Bras Cir Dig,2023(36):e1722.
[18] KIM W,SEO J M.Necrotizing enterocolitis[J].N Engl J Med,2011,364(3):255-264.
[19] ROCHEREAU N,MICHAUD E,WAECKEL L,et al.Essential role of TOSO/FAIM3 in intestinal IgM reverse transcytosis[J].Cell Rep,2021,37(7):110006.
[20] WEI H,WANG J Y.Role of polymeric immunoglobulin receptor in IgA and IgM transcytosis[J].Int J Mol Sci,2021,22(5):2284.
[21] COSTELLO C M,WILLSEY G G,RICHARDS A F,et al.Transcytosis of IgA attenuates salmonella invasion in human enteroids and intestinal organoids[J].Infect Immun,2022,90(6):e0004122.
[22] 吴晓霞,任红霞,詹江华.新生儿肠闭锁术后早期肠内营养发生坏死性小肠结肠炎的诊疗分析[J].中华小儿外科杂志,2019,40(4):324-327.
[23] BETHELL G S,HALL N J.Recent advances in our understanding of NEC diagnosis,prognosis and surgical approach[J].Front Pediatr,2023(11):1229850.
[24] BERGHOLZ R,ZSCHIEGNER M,ESCHENBURG G,et al.Mucosal loss with increased expression of IL-6,IL-8,and COX-2 in a formula-feeding only neonatal rat model of necrotizing enterocolitis[J].J Pediatr Surg,2013,48(11):2301-2307.
[25] YUAN Y,DING D,ZHANG N,et al.TNF-α induces autophagy through ERK1/2 pathway to regulate apoptosis in neonatal necrotizing enterocolitis model cells IEC-6[J].Cell Cycle,2018,17(11):1390-1402.
[26] XIA X,WANG D,YU L,et al.Activated M1 macrophages suppress c-kit expression via TNF-α-mediated upregulation of miR-222 in Neonatal Necrotizing Enterocolitis[J].Inflamm Res,2021,70(3):343-358.
[27] 罗厚忠,雷贤明,陈娟,等.坏死肠道切除及肠道造瘘术治疗新生儿坏死性小肠结肠炎:附82例报告[J].中国普通外科杂志,2019,28(4):507-511.

肠腹壁造口对新生儿坏死性小肠结肠炎免疫指标和感染指标的影响

Effect of enterostomy on immune indexes and infection indexes in necrotizing enterocolitis

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