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目的探讨静脉输注丙种球蛋白(IVIG)与新生儿溶血病(HDN)患儿坏死性小肠结肠炎(NEC)发生的关系。方法收集重庆医科大学附属儿童医院2013年1月1日至2014年1月1日确诊为HDN患儿的临床资料,采用倾向评分配比法建立回顾性队列研究,根据是否使用IVIG分为IVIG组和非IVIG组,比较两组患儿NEC发生情况。进一步以配比后病例建立病例对照研究,探讨溶血病患儿发生NEC的危险因素。结果共1 217例HDN患儿纳入研究,其中40例合并NEC,309例进行IVIG。进行1∶2的倾向评分配比后,共有199对匹配成功,其中NEC组25例,非NEC组572例。结果显示,倾向评分配比后,IVIG治疗并未增加溶血病患儿NEC的发生率,4.5%(9/199)vs 4.0%(16/398),χ2=0.083,P=0.773。单因素分析显示,早产、低出生体重、多胎、胎膜早破、产前糖皮质激素、静脉营养、先天性心脏病、最高胆红素值与溶血病患儿发生NEC有关。二元Logistic回归显示,先天性心脏病是溶血病患儿发生NEC的独立危险因素(OR:4.021,95%CI:1.286~12.578)。结论 IVIG治疗不增加溶血病患儿发生NEC的概率,合并先天性心脏病的HDN患儿更易发生NEC。
Objective To investigate the relationship between intravenous gamma globulin (IVIG) and necrotizing enterocolitis (NEC) in children with hemolytic disease (HDN). Methods The clinical data of children with HDN diagnosed from January 1, 2013 to January 1, 2014 in Children’s Hospital of Chongqing Medical University were collected retrospectively. The retrospective cohort study was conducted according to whether the use of IVIG was divided into IVIG group And non-IVIG group, compared the incidence of NEC in both groups. A case-control study was further established to compare the risk factors of NEC in children with hemolytic disease. Results A total of 1 217 cases of HDN were enrolled in the study, of which 40 cases had NEC and 309 cases had IVIG. After a 1: 2 propensity score, a total of 199 matched pairs were successful, including 25 in the NEC group and 572 in the non-NEC group. The results showed that IVIG treatment did not increase the incidence of NEC in children with hemolytic disease after the propensity score, 4.5% (9/199) vs 4.0% (16/398), χ2 = 0.083, P = 0.773. Univariate analysis showed that preterm birth, low birth weight, multiple births, premature rupture of membranes, prenatal glucocorticoid, parenteral nutrition, congenital heart disease, and the highest bilirubin value were associated with NEC in children with hemolytic disease. Binary logistic regression showed that congenital heart disease was an independent risk factor for NEC in children with hemolytic disease (OR: 4.021, 95% CI: 1.286-12.578). Conclusion IVIG treatment does not increase the probability of occurrence of NEC in children with hemolytic disease, NID is more likely to occur in HDN children with congenital heart disease.