| Background:NECrotizing enterocolitis（NEC）is a critical disease in neonates.With the development of medical technology,the survival rate of preterm infants has increased and the morbidity of NEC also increased.Surgeries are needed for those with poor outcomes treated conservatively but the mortality can be up to 50%.If the surgical intervention is performed too early,the growth will be affected but if too late,mortality and complications will increase.Therefore,it is very important to accurately determine the timing of surgery.Studies have found that intestinal biomarkers reflecting the severity of NEC can be detected in blood,feces,and urine.Blood sampling is invasive and the feces in fasting infants is always unavailable.By contrast,urine sampling is convenient and non-invasive,which makes it an ideal source of specimens.Claudin-3,high-mobility group box1（HMGB-1）,humanβ-defensin-2（HBD-2）,intestinal-specific resistance molecule（Relm-β）can be detected in urine and increase with the severity of diseases.Our study aims to determine the value of these urine biomarkers in predicting the timing of surgery for NEC.Method:Children diagnosed with NEC at Bell stage IIB or above in the Neonatal Center of Children’s Hospital of Chongqing Medical University from March 2019 to November 2020 were enrolled in our study.They were divided into surgery and non-surgery group according to the treatment.Urine samples were collected within 24 hours after the diagnosis of NEC and enzyme linked immunosorbent assay（ELISA）was used to determine the concentration of HMGB-1,Claudin-3,HBD-2,and Relm-β.At the same time,the clinical data was collected and analyzed.Result:During the study period,75 infants were enrolled and 51 were finally included in the study with 25 in surgery group and 26 in non-surgery group.Claudin-3,HMGB-1,and Relm-βin urine were significantly higher in surgery group（p<0.05）and the ROC curve of Claudin-3,HMGB-1,Relm-βsuggested that they have moderate value in assessing the surgical timing of NEC(AUC（Claudin3）=0.774 p=0.001;AUC（HMGB1）=0.874,p=0.000;AUC（Relm-）β</sub>=0.0.819,p=0.000).Infants in surgery group were more likely to show abdominal distension（p<0.05）while those in non-surgery group had higher rate of pneumatosis intestinalis（p<0.05）.ROC curve showed high values of Claudin-3,HMGB-1,Relm-βcombined with abdominal distension and portal pneumothorax on imaging to assess the surgical timing of NEC（AUC（≥3 items）=0.921,p=0.000）.Conclusion:Claudin-3,HMGB-1,and Relm-βin urine are helpful in the determination of surgical timing in NEC and if combined with the manifestation of abdominal distension,portal pneumothorax on imaging,the specificity will be incrased. |
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