Abstract:

Objective　To investigate the relationship between Neuroligin2 and growth-associated protein 43 (GAP-43) and Hirschsprung associated enterocolitis (HAEC) after surgery in children with Hirschsprung's disease and their combined predictive value. Methods　Seventy-nine children with Hirschsprung's disease who underwent megacolonectomy in Zhoukou Central Hospital from July 2020 to July 2022 were selected as the study group, and 79 children who underwent health checkups in Zhoukou Central Hospital from July 2020 to July 2022 were selected as the control group. Seventy-nine children with Hirschsprung's disease were followed up for 6 months after operation, and according to whether they were complicated with HAEC during the postoperative follow-up, they were divided into a HAEC group (23 cases) and a non-HAEC group (56 cases). There were 43 males and 36 females in the study group, aged (8.92±0.84) months. There were 45 males and 34 females in the control group, aged (8.84±0.88) months. The relative expression levels of serum Neuroligin2 and GAP-43 were detected after admission, and their correlations with the complication of HACE and their predictive values for postoperative HAEC in children with Hirschsprung's disease were analyzed. χ² test was used for the count data, independent sample t test was used for the measurement data, Spearman correlation analysis was performed, logistic regression equation was used to analyze the related influencing factors, and receiver operating characteristic curve (ROC) was used for predictive value analysis. Results　The relative expression levels of serum Neuroligin2 and GAP-43 in the study group [(0.35±0.03) and (1.52±0.31)] were lower than those in the control group [(0.79±0.07) and (2.47±0.39)], with statistically significant differences (t=51.351 and 16.949, both P<0.001). The relative expression levels of serum Neuroligin2 and GAP-43 in the HAEC group [(0.12±0.03) and (0.74±0.06)] were lower than those in the non-HAEC group [(0.44±0.05) and (1.84±0.12)], with statistically significant differences (t=28.587 and 41.756, both P<0.001). The relative expression levels of Neuroligin2 and GAP-43 in serum were negatively correlated with concurrent HACE (both P<0.05). Serum Neuroligin2 relative expression level (>0.35) and GAP-43 relative expression level (>1.52) were protective factors for postoperative HAEC in children with Hirschsprung's disease (both P<0.05). The area under the curve (AUC) of the combination of serum Neuroligin2 and GAP-43 in predicting HAEC in children with Hirschsprung's disease was 0.802, with the best predictive sensitivity and specificity of 86.96% and 73.21%, respectively. Conclusion　The relative expression levels of serum Neuroligin2 and GAP-43 in children with Hirschsprung's disease can be used in the assessment and prediction of postoperative HAEC, providing a reference basis for early and targeted clinical intervention to improve the prognosis.

Key words:

Hirschsprung's disease, Enterocolitis, Prediction, Neuroligin2, GAP-43, Children

摘要：

目的　探讨Neuroligin2、生长相关蛋白43（GAP-43）与小儿先天性巨结肠症术后并发小肠结肠炎（HAEC）的关系及联合预测价值。方法　选取2020年7月至2022年7月于周口市中心医院接受巨结肠切除手术的79例先天性巨结肠症患儿为研究组，另选取2020年7月至2022年7月于周口市中心医院健康体检儿童79例作为对照组。79例先天性巨结肠症患儿术后随访6个月，根据术后随访是否并发HAEC将患儿分为HAEC组（23例）和非HAEC组（56例）。研究组男43例、女36例，月龄（8.92±0.84）个月；对照组男45例、女34例，月龄（8.84±0.88）个月。入院后均检测血清Neuroligin2、GAP-43相对表达量，分析其与并发HACE的相关性及对小儿先天性巨结肠症患儿术后并发HAEC的预测价值。计数资料采用χ²检验，计量资料采用独立样本t检验，行Spearman相关性分析，logistic回归方程分析相关影响因素，预测价值分析采用受试者工作特征曲线（ROC）。结果　研究组血清Neuroligin2、GAP-43相对表达量［（0.35±0.03）、（1.52±0.31）］均低于对照组［（0.79±0.07）、（2.47±0.39）］，差异均有统计学意义（t=51.351、16.949，均P<0.001）。HAEC组血清Neuroligin2、GAP-43相对表达量［（0.12±0.03）、（0.74±0.06）］均低于非HAEC组［（0.44±0.05）、（1.84±0.12）］，差异均有统计学意义（t=28.587、41.756，均P<0.001）。血清Neuroligin2、GAP-43相对表达量与并发HACE均呈负相关（均P<0.05）。血清Neuroligin2相对表达量（>0.35）、GAP-43相对表达量（>1.52）是先天性巨结肠症患儿术后并发HAEC的保护因素（均P<0.05）。血清Neuroligin2、GAP-43相对表达量联合预测先天性巨结肠症患儿后并发HAEC的曲线下面积（AUC）为0.802，最佳预测灵敏度、特异度分别为86.96%、73.21%。结论　先天性巨结肠症患儿血清Neuroligin2、GAP-43相对表达量可用于术后并发HAEC的评估预测中，为临床早期针对性制定干预方案提供参考依据，以改善预后。

关键词:

先天性巨结肠, 小肠结肠炎, 预测, Neuroligin2, 生长相关蛋白43, 儿童