Role střevní bariéry v patogenezi a diagnostice nekrotizující enterokolitidy a nespecifických střevních zánětů

Coufal, Štěpán

Disruption of gut microbiota, altered mucosal defense, inappropriate immune response and gut barrier damage are all typical features in the pathogenesis of both necrotizing enterocolitis (NEC) and inflammatory bowel disease (IBD). Despite of intensive research, the exact pathogenesis of both diseases remains unclear and the diagnostics and outcome prediction are still problematic. Therefore, we analyzed the role of gut-associated and inflammatory biomarkers, with respect to different aspects of gut barrier dysfunction in the pathogenesis of both disease, with the aim to improve the diagnostics and to predict the disease course and outcome. Using ELISA, we found that patients who will later develop NEC have significantly higher intestinal fatty acid-binding protein (I-FABP) than infants who will later develop sepsis already in first hours after NEC suspicion. Urinary I-FABP had high sensitivity (81%) and specificity (100%) and its addition to currently used gold standard for NEC diagnosis increased its sensitivity and negative predictive value. We found that serum amyloid A (SAA) was the strongest factor for prediction of the most severe stage of NEC. The combination of intestinal and liver FABP with SAA predicted the length of hospitalization in NEC patients and the low level of SAA predicted short...

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