早产儿脑损伤与宫内感染引起细胞因子网络反应的临床研究

Premature Brain Damage and Intrauterine Infection Cause Cytokine Network Response

目的研究宫内感染与早产儿脑损伤的因果关系,从细胞因子网络反应角度探讨宫内感染早产儿脑损伤机制,为防治早产儿脑损伤提供新途径。方法将100例早产儿根据头颅超声及CT检查结果分为早产脑损伤组(31例)和早产无脑损伤组(69例)。通过对2组胎膜、胎盘的病理检测(主要以检测绒毛膜羊膜炎为主),判断是否有宫内感染导致的早产儿脑损伤。采用酶联免疫吸附试验(ELISA)检测2组血清中细胞因子[IL-1β、IL-6、IL-10及肿瘤坏死因子(TNF-α)]的水平。结果 100例患儿中发生宫内感染40例,60例为非宫内感染,宫内感染患病率为40.0%。宫内感染患儿脑损伤的患病率为47.5%(19/40),非宫内感染患儿脑损伤的患病率为20.0%(12/60)。宫内感染患儿脑损伤患病率显著高于非宫内感染患儿(χ2=8.485,P<0.05)。早产脑损伤组IL-1β、IL-6、IL-10及TNF-α分别为(6.33±2.17)(8.20±4.10)(1.46±0.25)及(5.35±2.00)μg·L-1;早产无脑损伤组IL-1β、IL-6、IL-10及TNF-α分别为(1.44±1.01)(1.58±2.33)(1.65±0.30)及(3.57±1.33)μg·L-1。早产脑损伤组IL-1β、IL-6、TNF-α显著高于早产无脑损伤组,IL-10低于早产无脑损伤组(均P<0.05)。结论早产儿脑损伤与宫内感染关系密切,细胞因子网络反应可能介导该损伤过程。

ABSTRACT:Objective To explore the causality relationship between intrauterine infection and brain damage in premature infants,to observe the mechanism of brain damage in premature in-fants with intrauterine infection from the perspective of cytokine network response,and to provide a new way of preventing premature brain damage.Methods According to head ultrasound and CT results,100 premature infants were divided into brain damage group(n = 31)and non-brain damage group (n = 69 ).Intrauterine infection-induced premature brain damage was observed through pathological examinations of fetal membranes and placenta(mainly chorioamnionitis).In addition,serum levels of cytokines interleukin-1β(IL-1β),interleukin-6 (IL-6 ),interleukin-10 (IL-10)and tumor necrosis factor-α(TNF-α)were detected by ELISA.Results The prevalence of intrauterine infection was 40.0%(40/100).The incidence of brain damage in infants with intrau-terine infection(47.5%,19/40)was significantly higher than that in infants without intrauterine infection(20.0%,12/60)(χ2 =8.485,P <0.05).Moreover,infants with brain damage had higher&nbsp;levels of IL-1β,IL-6 and TNF-αand lower levels of IL-10 than infants with non-brain damage((6. 33±2.17),(8.20±4.10),(1.46±0.25)and(5.35±2.00)μg·L-1 vs(1.44±1.01),(1.58±2. 33),(1.65±0.30)and(3.57 ± 1.33)μg· L-1 ,respectively;P <0.05).Conclusion Premature brain damage is positively associated with intrauterine infection,and the cytokine network re-sponse may mediate the damage process.