脐血中胃饥饿素及抑制摄食因子Ｇ1水平对早产儿喂养不耐受的预测价值

Predictive value of ghrelin and feeding inhibitor Ｇ1 levels in umbilical cord blood on feeding intolerance in preterm infants

摘要

目的 探讨脐血中胃饥饿素(Ghrelin)、抑制摄食因子Ｇ1(Nesfatin-Ｇ1)水平对早产儿喂养不耐受(FI)的预测价值。方法 选取2022年10月至2023年10月期间于河北大学附属医院出生并入住新生儿重症监护室(NICU)住院治疗的89例出生胎龄＜32周早产儿为研究对象,根据喂养情况将其分为FI组(n＝49)与喂养耐受(FT)组(n＝40).所有纳入研究的早产儿均于娩出后留取脐血2mL,采用酶联免疫吸附法(ELISA)测定脐血中Ghrelin、Nesfatin-Ｇ1水平,采用Pearson相关系数分析FI组早产儿脐血中Ghrelin、Nesfatin-Ｇ1水平与FI持续时间的相关性,应用受试者工作特征(ROC)曲线分析脐血中Ghrelin、Nesfatin-Ｇ1水平对早产儿FI的预测价值。结果 FI组早产儿脐血中Ghrelin水平明显低于FT组,而脐血中Nesfatin-Ｇ1水平明显高于FT组,差异均有统计学意义(Z值分别为-7.566、-5.457,P＜0.05).FI组早产儿达到全肠道喂养的时间、住院天数均明显大于FT组,而出院前体重、出院前身长、出院前头围均明显小于FT组,差异均有统计学意义(t值分别为18.595、7.151、-5.003、-8.757、-8.866,P＜0.05).FI组早产儿脐血中Ghrelin水平与FI持续时间负相关(r＝-0.948,P＜0.05),脐血中Nesfatin-Ｇ1水平与FI持续时间正相关(r＝0.952,P＜0.05).ROC曲线分析显示,脐血中Ghrelin、Nesfatin-Ｇ1水平预测早产儿发生FI的曲线下面积(AUC)分别为0.966、0.837,灵敏度分别为91.80％、79.60％,特异度分别为90.00％、77.50％。结论 FI早产儿脐血中Ghrelin水平明显降低,Nesfatin-Ｇ1水平明显升高,两者与早产儿FI的发生密切相关,Ghrelin和Nesfatin-Ｇ1对预测早产儿FI有一定的价值,需引起临床注意.

Abstract

Objective To investigate the predictive value of ghrelin and Nesfatin-Ｇ1 levels in umbilical cord blood on feeding intolerance (FI) in preterm infants. Methods 89 cases of premature infants ＜32 weeks born in the Affiliated Hospital of Hebei University from October 2022 to October 2023 and admitted to the neonatal intensive care unit (NICU) for treatment were selected as the research subjects, and they were divided into FI group (n＝49) and feeding tolerance (FT) group (n＝40) according to feeding conditions. All preterm infants included in the study were left with 2mL of umbilical cord blood after delivery, and the levels of Ghrelin and Nesfatin-Ｇ1 in umbilical cord blood were determined by enzyme-linked immunosorbent assay (ELISA), the correlation between the levels of Ghrelin and Nesfatin-Ｇ1 in the umbilical cord blood of preterm infants in the FI group and the duration of FI was analyzed by Pearson correlation coefficient, and the receiver operating characteristic (ROC) curve was used to analyze the Ghrelin and Nesfatin-Ｇ1 levels in the umbilical cord blood. Predictive value of Nesfatin-Ｇ1 levels on FI in preterm infants. Results The level of Ghrelin in the umbilical cord blood of preterm infants in the FI group was significantly lower than that in the FT group, while the level of Nesfatin-Ｇ1 in the umbilical cord blood was significantly higher than that in the FT group, and the differences were statistically significant (Z values were -7.566 and -5.457, P＜0.05, respectively). The time and length of hospitalization of preterm infants in the FI group were significantly greater than those in the FT group, while the pre-discharge weight, pre-discharge length, and head circumference before discharge were significantly smaller than those in the FT group, and the differences were statistically significant (t-values were 18.595, 7.151, -5.003, -8.757, -8.866, P＜0.05, respectively). The level of Ghrelin in the umbilical cord blood of preterm infants in the FI group was negatively correlated with the duration of FI (r＝-0.948, P＜0.05), and the level of Nesfatin-Ｇ1 in the umbilical cord blood was positively correlated with the duration of FI (r＝0.952, P＜0.05). ROC curve analysis showed that the AUC of Ghrelin and Nesfatin-Ｇ1 levels in umbilical cord blood for predicting the occurrence of FI in preterm infants was 0.966 and 0.837, respectively, with sensitivity of 91.80% and 79.60%, and specificity of 90.00% and 77.50%, respectively. Conclusion The level of Ghrelin in the cord blood of FI preterm infants was significantly decreased, and the level of Nesfatin-Ｇ1 was significantly increased, which were closely related to the occurrence of FI in preterm infants.

关键词

脐血 / 胃饥饿素 / 抑制摄食因子Ｇ1 / 早产儿 / 喂养不耐受 / 生长发育

Key words

umbilical cord blood / ghrelin / inhibition of feeding factor-Ｇ1 / preterm infant / feeding intolerance / growth and development

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基金资助

河北大学医学学科培育项目(2023B05)

河北大学附属医院基金项目(2023QA02)

2019年河北省医学科学研究课题计划(20190938)