脐血IL-6、IL-8、TNF-a在早产儿脑损伤中的临床意义及预测价值

Clinical significance and predictive value of umbilical cord serum IL-6,IL-8 and TNF-a in preterm newborn brain damage

目的研究脐血白介素-6(IL-6)、白介素-8(IL-8)和肿瘤坏死因子-a(TNF-a)在34周前早产儿脑损伤中的临床意义及预测价值。方法对59例34周前出生早产儿用酶联免疫吸附试验检测脐血IL-6、IL-8、TNF-a;将母亲的胎盘胎膜组织行病理学检查,诊断有无绒毛膜羊膜炎;早产儿出生后72 h内头颅超声检查,诊断有无脑损伤。结果 (1)早产儿脑损伤组脐血IL-6[(7.69±1.69)μg/L]、IL-8[(3.87±0.26)μg/L]及TNF-a[(3.67±1.12)μg/L]明显高于无脑损伤组[分别为(5.78±0.59)μg/L、(1.79±0.66)μg/L、(1.91±0.37)μg/L],2组比较差异有统计学意义(P<0.05);母亲患绒毛膜羊膜炎组脐血IL-6[(6.98±0.17)μg/L]、IL-8[(3.27±0.27)μg/L]和TNF-a[(3.24±1.37)μg/L]明显高于无绒毛膜羊膜炎组[分别为(6.13±0.15)μg/L、(2.04±0.79)μg/L、(2.07±0.54)μg/L],2组比较差异有统计学意义(P<0.05);(2)应用ROC工作曲线进行分析,脐血IL-6≥6.46μg/L、IL-8≥2.0μg/L、TNF-a≥2.42μg/L作为诊断早产儿脑损伤标准时,其灵敏度分别为95.5%、95.5%和100%;特异度分别为94.6%、70.3%和97.3%;(3)母亲有绒毛膜羊膜炎时,早产儿脑损伤发生率明显升高。结论脐血IL-6、IL-8和TNF-a不仅反映母亲的感染情况和早产儿脑损伤,并且对早产儿脑损伤具有一定的预测价值。

Objective To study Clinical significance and predictive value of umbilical cord serum IL-6,IL-8 and TNF-a in less than 34 gestational weeks preterm newborn brain damage.Method 59 preterm newborns less 34 weeks were involved,the umbilical cord serum IL-6,IL-8 and TNF-a concentration of preterm newborns were detected by enzyme linked immunosorbent assaay;Maternal chorioamnioamnionitis was determined by histologic examination;Brain damage was diagnosed by ultrasonography at postnatal 72 hours.Result （1） Umbilical cord serum IL-6,IL-8 and TNF-a [（7.69±1.69）μg/L,（3.87±0.26）μg/L and（3.67±1.12）μg/L,respectively] concentrations in preterm newborn with brain damages were significantly higher than those without brain damages [（5.78±0.59）μg/L,（1.79±0.66）μg/L and（1.91±0.37） μg/L,respectively];Umbilical cord serum IL-6,IL-8 and TNF-a [（6.98±0.17）μg/L,（3.27±0.27）μg/L and（3.24±1.37）μg/L,respetively] concentrations in preterm newborn whose mothers had chorioamniotitis were significantly higher than those without chorioamniotitis [（6.13±0.15）μg/L,（2.04±0.79）μg/L and（2.07±0.54）μg/L,respectively];（2） According to ROC curve,the umbilical cord serum IL-6≥6.46 μg/L,IL-8≥2.0 μg/L and TNF-a≥2.42 μg/L were used as criteria to diagnose the brain damage;the sensitivity was 95.5%,95.5% and 100%,respectively;the specificity were 94.6%,70.3% and 97.3%,respectively.（3） The incidence of brain damage was higher in those whose mother had choriamnionitis.Conclusion Umbilical cord IL-6,IL-8 and TNF-a concentration might be the link between maternal infection and brain damages in preterm newborns,and it is valuable for early diagnosis of preterm newborn brain damage.