The Value About Laboratory Testing Uesd To Assist Decision Of The Surgery In Premature Preterm Infants With Necrotizing Enterocolitis And The Quantitative Proteomic Serum Analysis

PARTⅠThe Value about Laboratory Testing uesd to assist Decision of the Surgery in Premature Preterm Infants with Necrotizing EnterocolitisBackground Necrotizing enterocolitis(necrotizing enterocolitis,NEC)is a serious diease that threaten infants’ health obviously.It has high fatality rate,poor prognosis.The clinical manifestations are gastric retention,abdominal distension,bloody stool and other intestinal symptoms,or apnea,low reaction,shock and other symptoms of systemic poisoning.At present the principles and methods of the treatment about this disease has a relatively uniform,including absolutly fasting,continuous gastrointestinal decompression,antibiotics application,some conservative medical treatment and necrosis of bowel resection surgery etc.The development of NEC in children whose NEC is between ⅡB and ⅢA is rapid and the performance is not obvious.The relative indications for surgery is difficult to grasp.At this time,the application of internal medicine conservative treatment to control the development of the disease,or actively remove intestinal lesions,whether there are clinical specific indicators to assist treatment,are the problems we need to think about.Objective In this paper,we will discuss the correlation between laboratory test and NEC operation,evaluating the role of serum markers in NEC surgery for guiding the timing of clinical operation.Method In this research,We collected the clinical data of 30 cases of NEC patients with gestational age of less than 33 weeks in very preterm infants department of Bayi Children’s Hospital affiliated to General Hospital of Chinese PLA Army.And these collected patients’ NEC is above Bell stage Ⅱ.According to the therapeutic schedule,16 cases were divided into operation group and the others were conservative group.Methods Retrospective analysis and SPSS 19.0 were used to analyze and compare and laboratory test indicators after three consecutive days of the NEC operation group and the conservative group.Research factors include White blood cell count,granulocyteratio,platelet count,C reactive protein count within three days after onset.Result NEC surgery is correlated with the WBC count and CRP values of the first day,the platelet count and CRP of the second day,and the platelet counts and CRP of the third day after sick.The low platelet count is an independent factor for NEC surgery.Aimed at it,we analyzed the ROC curve and calculated the cut-off value which was 144.5*109/l,the sensitivity,specificity,positive predictive value,negative predictive value and the value were 81.3%,87.5%,89.45%,91.52%,respectively.Conclusion 1.NEC surgery is correlated with the WBC count and CRP values of the first day,the platelet count and CRP of the second day,and the platelet counts and CRP of the third day after sick.2.The low platelet count in 24-48 hours after onset is an independent factor for NEC surgery.When the count is lower than 144.5 *109/l,suggesting that at this time the operation needs more necessary,We need to combine the clinical course of children,so as to make a better treatment plan,grasp the best timing of surgery.PART Ⅱ Quantitative Proteomic Study about Serum from Preterm Infants with Necrotizing EnterocolitisObjective: Necrotizing enterocolitis(necrotizing enterocolitis NEC)is an acute inflammatory intestinal disease caused by a variety of reasons.Due to to intestinal dysfunction and immature,weakened immune system,premature infants are more likely to happen.It has atypical clinical symptoms,rapid prgress,high mortality,poor prognosis and greatly threatens infants’ health and quality of life.Now that it is considered that the pathogenesis of NEC is bacteria translocation and reproduction in the intestinal when the intestinal epithelial barrier function is low or the destruction of intestinal blood supply is bad,food influlence,a large number of inflammatory mediators produce,inducing the damage of intestinal,intestinal perforation and necrosis,systemic inflammatory response syndrome,even shock,multiple organ failure.Although recent studies on NEC heat continues to rise,but the molecular mechanism of proteomics literature is less.Protein group(Proteomics)is a dynamic study of all protein expression of cell,tissue or organism from the overall perspective.Differential proteomic analysis is a study to find the differences between the various periods.Tandem Mass Tags is a technical applicating the isotope labeling,analyze tandem mass,compare the relative content of protein samples in parallel by the specific markers of the polypeptide amino group.Therefore,this study will apply TMT technology to research NEC premature serum quantitative proteomics by the molecular cytological information,obtiane a deeper understanding about the development mechanism of disease using of molecular cytological information.Methods: We collected 2 cases of preterm twins which were hospitalized in the preterm neonatal intensive care unit affiliated to General Hospital of Chinese PLA Army.One of them was diagnosed with NEC,Bell stageⅢA,24 hours after birth in hospital,gestational age 30 weeks,the feeding amount was 110ml/kg/d before sick.The other is one of the twins(without NEC,the condition is relatively stable,no severeinfection),hospitalized in the same period.Blood samples were collected,wiped off the serum high abundance proteins,inspected the sample quality,TMT marked protein by TMT.The sample graded though C18 column,spectrometry quantitative detection and analysis,differential protein mass spectrometry data is obtianed.All the difference protein gene ID information inported the KOBAS 2 software to analyze the signal pathway,disease and GO enrichment.Result:1.A total of 1515 proteins were identified and quantified.The expression up-regulated by 2.0 times or reduced by 0.5,the p-value of the paired t test was less than 0.05,as a screening standard for the differential protein.44 differential proteins were found,including 20 down-regulated species and 24 up-regulated species.2.The significantly enriched biological processes are platelet activation,complement and coagulation cascade,protein degradation,detoxification of reactive oxygen species,cross-presentation of exogenous antigens,regulation of carbohydrate metabolism,regulation of cell apoptosis and so on.Significantly enriched pathways included TGFreceptor signal transduction pathway,the P53 signaling pathway,Hedgehog signaling pathway and so on.Conclusion: 1.The quantitative proteomics technolgy of TMT can be used to select differentially expressed proteins in infants with NEC.2.In this study,44 kinds of differential proteins with high reliability were screened out by exploring the specific serum markers and pathogenesis of NEC.Significantly enriched biological processes include platelet activation,reactive oxygen species detoxification,wound healing,etc.A variety of proteins are also involved in the biological activity of platelet degranulation,platelet activation,etc.Combing with the first part of the content,it reveals the platelet-related biological processes and the occurrence of NEC has a direct relationship,under a variety of pathological factors.3.On the basis study of proteomics,this study selected enriched signaling pathways,suggesting that NEC involving the TGF-receptor signaling pathway,P53 signaling pathway,Hh signaling pathway and so on,this pathwey madidated many biological process,such as Epithelial-Mesenchymal transition,intestinal cell apoptosis,intestinal tissue damage and repair,maintenance of barrier integrity about intestinal tight junction.