Study On The Diagnostic Value Of Damage-associated Molecular Patterns (DAMPs) In Neonatal Necrotizing Enterocolitis Based On Evidence-based Medicine

Objective:To study the changes of damage-associated molecular patterns(DAMPs)in children with neonatal necrotizing enterocolitis(NEC)and the value in diagnosis and predicting the severity of NEC as biomarkers,in order to provide new ideas and strategies for early diagnosing NEC and avoiding the serious complications of NEC.Methods:Through evidence-based medical methods,the databases such as Web of science,Pub Med/Medline,Embase,China National Knowledge Infrastructure(CNKI)and Wanfang database were systematically searched to determine the literatures related to DAMPs and NEC(the retrieval time is limited to the establishment of the databases until March 2020).Two independent researchers screened the literatures according to the inclusion criteria and exclusion criteria,and evaluated the quality of the included studies,extracted the data from them,and analyzed the extracted data of each group by Review Manager 5.4.Results:We screened 774 literatures and finally included 22 literatures eligible for inclusi-on.Six were in Chinese and 16 were in English.The molecules found to be studied as DAMPs include: high mobility histone B1(HMGB1),human β-defensins 1(HBD1),human β-defensins 2(HBD2),heat shock protein(HSP),S100 calcium-binding protein A12(S100 A12),S100 calcium-binding protein A8/A9(S100A8/A9),fecal calprotectin(FC).The sample size of the studies ranged from 10 to 159,total of 1414,and included 510 NEC patients and 904 non-NEC controls.The results of our metaanalysis show that,between NEC patients and matched non-NEC controls,there were significant differences in HMGB1 levels in feces(n=102,SMD=2.89,95%CI=(2.32,3.46),Z=9.98,P<0.00001);there were significant differences in S100A12 levels in feces and serum(n=576,SMD=1.19,95%CI=(0.54,1.85),Z=3.57,P=0.0004);There were significant differences in FC levels(n=385,SMD=1.70,95% CI=(0.88,2.51),Z=4.09,P<0.0001);but there was no difference in HBD2 levels in feces(n=131,SMD=0.57,95% CI=(-0.25%,1.39),Z=1.37,P=0.17).For the rest of the DAMPs,only one literature or the data that could not be analyzed was without meta-analysis.Conclusions:The results of this study show that fecal HMGB1/serum and fecal S100A12/FC are elevated in NEC and may have reference value in NEC diagnosis,but fecal HBD2 does not have judgment value.FC can be used as a reference biomarker for early diagnosis NEC and has the value of indicating the severity of the disease.