早产儿脑损伤脐血细胞因子水平及临床意义

Cord blood cytokines in brain injury in preterm children and their clinical significance

目的探讨脐血细胞因子在早产儿脑损伤中的水平及临床意义。方法对象为2008年6月-2010年6月佛冈县人民医院产科分娩的85例早产儿,出生后3-7d内进行头颅超声或CT检查、NBNA测定及早期运动发育指标检测,分为脑损伤组（17例）和无脑损伤组（68例）,用ELISA方法检测早产儿脐带血细胞因子IL-1β,IL-6,TNF-a,IL-10水平;孕母胎盘进行绒毛膜羊膜炎检测。结果 1）脑损伤组脐带血IL-1β,IL-6,TNF-α水平分别为（6.53±3.17）μg/L、（7.95±4.32）μg/L和（5.43±1.82）μg/L,均高于无脑损伤组（1.53±1.22）μg/L、（1.65±2.10）μg/L和（3.23±0.83）μg/L;而IL-10水平为（1.21±0.23）μg/L,低于无脑损伤组（1.59±0.25）μg/L;上述差异均有统计学意义（P均〈0.05）。2）脑损伤组孕母绒毛膜羊膜炎发生率高达76.47%（13/17例）显著高于无脑损伤组22.05%（15/68例）,差异有显著统计学意义（χ^2=15.84,P〈0.05）。结论细胞因子可能介导了宫内感染早产儿脑损伤的过程,对早产儿脑损伤有一定预测价值。

Objective To explore cord blood cytokines in brain injury in preterm children and their clinical significance. Methods Eighty-five preterm infants born in Qingyuan Fogang People＇s Hospital were enrolled in this study from Jun. 2008 to Jun. 2010. Cranial ultrasound or CT scan, detection of NBNA and early motor development index were executed within 3-7 days after birth to ascertain brain injury. All the babies were divided into the brain injury group （17 cases） and without brain injury group （68 cases） based on evidence of brain injury, ELISA was used to detect cytokine IL-1β, IL-6, tumor necrosis factor （TNF）-a, IL-10 level in cord blood from preterm infants. All the placentas were collected and pathologically examined for chorioamnionitis. Results 1）Cord blood levels of IL-1β,IL-6,TNF-α in the brain injury were （6.53±3.17）μg·L-1, （7.95±4.32）μg·L-1 and （5.43±1.82）μg·L-1 respectively, significantly higher than the control group [（1.53±1.22）μg·L-1, （1.65±2.10）μg·L-1 and （3.23±0.83）μg·L-1, respectively];IL-10 level in brain injury babies was 1.21±0.23μg·L-1,which was lower than the control group（1.59±0.25）μg·L-1.（p a0.05）. 2）Maternal chorioamnionitis rate in brain injury group was 76.47% （13 in 17 patients）, which was significantly higher than those without brain injury 22.05% （15in 68 patients）,showing significant statistically difference （χ2=15.84,P0.05）. Conclusions cytokines may be the key mediator of the injury in preterm infants. Cytokines on brain damage in preterm children have some predictive value.