目的探讨坏死性小肠结肠炎(NEC)新生儿血浆D-乳酸水平变化的意义。方法选择诊断为NEC 50例新生儿为NEC组(其中NECⅡ期30例,NECⅢ期20例)。选择同期非NEC新生儿50例为对照组。NEC组于NEC确诊24 h内,对照组于相应日龄取外周静脉血2 mL,采用酶联免疫吸附法检测血浆D-乳酸水平,采用受试者工作特性(ROC)曲线确定血浆D-乳酸阳性标准。根据NEC发生时血浆D-乳酸水平分为D-乳酸升高组和D-乳酸正常组,根据NEC患儿病情转归分为病死组和存活组,比较不同组间血浆D-乳酸水平、新生儿危重病例评分(NCIS)分值、并脓毒症的发生率、病死率的差异。结果 NECⅢ期组、NECⅡ期组和对照组血浆D-乳酸水平分别为(36.2±10.3)mg·L-1、(28.6±12.5)mg·L-1和(3.8±2.6)mg·L-1,3组比较差异有统计学意义(F=7.63,P<0.05)。ROC曲线分析显示,血浆D-乳酸阳性标准为≥7 mg·L-1,预测NEC的敏感性为80.0%,特异性为84.6%,假阴性率为15.4%,假阳性率为20.0%。D-乳酸升高组并脓毒症发生率、病死率较高,NCIS评分较低,与D-乳酸正常组比较差异均有统计学意义(Pa<0.05);病死组血浆D-乳酸水平、并脓毒症发生率较高,NCIS评分较低,与存活组比较差异均有统计学意义(Pa<0.05)。结论血浆D-乳酸水平能较敏感地反映NEC新生儿的病情,可作为预测NEC程度和预后的指标之一。 Objective To investigate the significance of plasma D-lactate levels in neonates with necrotizing enterocolitis (NEC). METHODS: Fifty newborn infants with NEC were selected as NEC group (30 in NECⅡ and 20 in NECⅢ). Select the same period non-NEC neonates 50 cases as the control group. NEC group within 24 hours of diagnosis of NEC, the control group at the appropriate age to take peripheral venous blood 2 mL, the level of plasma D-lactate was detected by enzyme-linked immunosorbent assay, receiver operating characteristic (ROC) curve to determine plasma D-lactate Positive standard. According to the level of plasma D-lactate in NEC, it is divided into D-lactate elevated group and D-lactate normal group. According to the condition of NEC children, the level of plasma D-lactate and the survival group are compared. Children critical illness score (NCIS) score, and the incidence of sepsis, mortality differences. Results The levels of plasma D-lactate in NEC group, NEC group and control group were (36.2 ± 10.3) mg · L-1, (28.6 ± 12.5) mg · L-1 and (3.8 ± 2.6) mg · L- , The difference between the three groups was statistically significant (F = 7.63, P <0.05). ROC curve analysis showed that the positive standard of plasma D-lactic acid was ≥7 mg · L-1. The predictive value of NEC was 80.0%, the specificity was 84.6%, the false negative rate was 15.4% and the false positive rate was 20.0%. D-lactic acid increased group and the incidence of sepsis, high mortality, NCIS lower scores, compared with the normal D-lactic acid group were statistically significant (P <0.05); D-lactic acid levels, The incidence of sepsis was higher, NCIS score was lower, and the difference between the two groups was statistically significant (Pa <0.05). Conclusions Plasma D-lactate level can reflect the neonatal status of NEC more sensitively and may be used as one of the indexes to predict the degree and prognosis of NEC.