探讨腹部超声联合血清激活素A、髓系细胞触发受体1（TREM1）诊断新生儿坏死性小肠结肠炎（NEC）的价值。

本研究为回顾性队列研究，纳入2022年11月至2025年12月西北妇女儿童医院就诊的261例经初步检查疑似NEC范畴的患儿作为研究对象，经临床诊断最终确诊NEC患儿102例（NEC组），非NEC患儿159例（非NEC组），记录患儿临床资料并进行腹部超声检查，采用酶联免疫吸附测定血清激活素A、TREM1水平。采用受试者工作特征（ROC）曲线评估血清激活素A、TREM1诊断NEC的价值；采用Kappa一致性检验评估腹部超声单独及联合血清激活素A、TREM1诊断NEC与临床诊断结果的一致性。

倾向性评分匹配后，非NEC组和NEC组妊娠年龄、早产、非母乳喂养等资料比较差异均无统计学意义（P>0.05），非NEC组和NEC组均102例患儿。腹部超声诊断NEC与临床诊断结果的一致性良好，Kappa值为0.745（P<0.05）。NEC组血清激活素A、TREM1水平较非NEC组显著升高（P<0.05）。血清激活素A、TREM1水平诊断NEC的曲线下面积（AUC）分别为0.814、0.824，临界值分别为687.60、476.88 pg/mL。腹部超声联合血清激活素A、TREM1诊断NEC与临床诊断结果的一致性较高，Kappa值为0.912（P<0.05）。联合诊断的特异度、准确度、阳性预测值相较于腹部超声、血清激活素A、TREM1单独诊断显著升高，灵敏度、阴性预测值较血清激活素A、TREM1单独诊断显著升高（P<0.05）。

腹部超声联合血清激活素A、TREM1可作为新生儿NEC有前景的诊断方法，有望改善NEC诊断准确度。

To explore the value of abdominal ultrasound combined with serum activin A and triggering receptors expressed on myeloid cells 1 (TREM1) in the diagnosis of neonatal necrotizing enterocolitis (NEC).

This study was a retrospective cohort study. From November 2022 to December 2025, 261 children who visited Northwest Women's and Children's Hospital and were preliminarily suspected of having NEC were included as the research subjects. After clinical diagnosis, 102 children were finally diagnosed with NEC (NEC group), and 159 children were diagnosed as non-NEC (non-NEC group). The clinical data of the patients were recorded and abdominal ultrasound examination was conducted. The levels of serum activin A and TREM1 were measured by enzyme-linked immunosorbent assay (ELISA). The value of serum activin A and TREM1 in diagnosing NEC was evaluated using the receiver operating characteristic (ROC) curve. Moreover, Kappa consistency test was used to evaluate the consistency of abdominal ultrasound alone and in combination with serum activin A and TREM1 in diagnosing NEC compared with the clinical diagnosis results.

After propensity score matching, there were no statistically significant differences in pregnancy age, preterm birth, and non-breastfeeding between the non-NEC group and the NEC group (P>0.05). Both the non-NEC group and the NEC group consisted of 102 children. The consistency between abdominal ultrasound diagnosis of NEC and clinical diagnosis results was good, with a Kappa value of 0.745 (P<0.05). The levels of serum activin A and TREM1 in the NEC group were obviously higher than those in the non-NEC group (P<0.05). The area under the curve (AUC) for diagnosing NEC using serum activin A and TREM1 levels was 0.814 and 0.824 respectively, with the cutoff values being 687.60 and 476.88 pg/mL. The combined use of abdominal ultrasound and serum activin A and TREM1 in diagnosing NEC showed a high consistency with the clinical diagnosis results, with a Kappa value of 0.912 (P<0.05). The specificity, accuracy and positive predictive value of the combined diagnosis were obviously higher than those of abdominal ultrasound, serum activin A and TREM1 alone. The sensitivity and negative predictive value were also obviously higher than those of serum activin A and TREM1 alone (P<0.05).

Abdominal ultrasound combined with serum activin A and TREM1 can be a promising diagnostic method for neonatal NEC, and is expected to improve the accuracy of NEC diagnosis.