Objective:To determine the predictive value of high-frequency ultrasonography for necrotizing enterocolitis (NEC) requiring surgical treatment in neonates.Methods:From January 2018 to December 2021, neonates diagnosed with NEC (Bell stage Ⅱ and above) in our hospital were retrospectively analyzed. The neonates were assigned into surgical group and non-surgical group according to the treatment. The following ultrasonography results were compared between the two groups: intestinal motility, gastrointestinal (GI) wall perfusion, pneumatosis intestinalis (PI), portal vein gas, peritoneal effusion translucency, depth of ascites fluid and GI wall thickness. Logistic regression was used to determine risk factors of surgical treatment for NEC. ROC curve was drawn to calculate the predictive value of combined and individual factors for NEC requiring surgical treatment.Results:A total of 40 neonates were enrolled, including 18 in the surgical group and 22 in the non-surgical group. No significant differences existed between the two groups in PI and depth of ascites fluid ( P>0.05). The surgical group had higher incidences of decreased intestinal motility, portal vein gas, reduced GI wall perfusion, poor peritoneal effusion translucency and thinner GI wall than the non-surgical group (all P<0.05). Logistic regression analysis showed that poor translucency of peritoneal effusion, thinning of GI wall, reduced GI wall perfusion and decreased intestinal motility were risk factors for surgical treatment of NEC. ROC curve showed that the cut-off value predicting surgical treatment based on GI wall thickness was 1.2 mm, with an area under the curve (AUC) of 0.746, sensitivity of 87.5% and specificity of 65.6%. The AUC of the combined factors predicting surgical treatment was 0.867, with sensitivity of 96.9% and specificity of 75.8%. Conclusions:Decreased intestinal motility and GI wall perfusion, thinning of GI wall and poor peritoneal effusion translucency on high-frequency ultrasonography have high predictive efficacy for the need of surgical treatment in the acute phase of NEC.

[摘 要] 目的：探讨番茄红素通过沉默信息调节因子1（SIRT1）/核因子-κB（NF-κB）轴对肾癌786-O细胞增殖、凋亡的影响。方法：常规培养人正常肾细胞HK-2和人肾癌细胞786-O，实验分为对照组（0.1% DMSO）、顺铂组（40 μg/mL）、番茄红素低质量浓度（2.5 μg/mL）组、番茄红素高质量浓度（5 μg/mL）组、番茄红素（5 μg/mL）+EX527（SIRT1抑制剂）（3 µmol/L）组。CCK-8法、克隆形成实验检测各组HK-2、786-O细胞的增殖能力，流式细胞术检测各组786-O细胞的凋亡，RH123、DCFH-DA染色分别检测各组786-O细胞的线粒体膜电位（MMP）、活性氧（ROS）水平，WB法检测各组786-O细胞中凋亡相关蛋白BAX、Bcl-2、C-casp3和SIRT1/NF-κB轴相关蛋白SIRT1、p-NF-κB蛋白的表达。786-O细胞移植瘤实验检测番茄红素低（5 mg/kg）、高质量浓度（20 mg/Kg）、顺铂（2 mg/kg）、番茄红素（20 mg/kg）+EX527（10 mg/kg）对移植瘤生长的影响，TUNEL法检测各组移植瘤组织中的细胞凋亡。结果：番茄红素呈剂量依赖性地抑制786-O细胞的增殖活性，番茄红素、顺铂均明显抑制786-O细胞的克隆形成能力且促进其凋亡，细胞中MMP损伤率升高而ROS水平降低，凋亡相关蛋白BAX、C-casp3表达均显著升高（均P<0.05）而Bcl-2表达下调（P<0.05），SIRT1表达显著升高（P<0.05）而p-NF-κB的表达显著降低（P<0.05），上述作用均可被EX527逆转；番茄红素、顺铂抑制786-O细胞移植瘤的生长且促进其细胞凋亡，其作用也能被EX527逆转。结论：番茄红素通过上调SIRT1、抑制NF-κB通路的激活进而抑制786-O细胞增殖且诱导其凋亡。