线粒体偶联因子6、细胞色素C在新生儿败血症中的变化及临床意义

Changes and clinical significances of mitochondrial coupling factor 6 and cytochrome C in neonatal sepsis

目的检测新生儿败血症时血浆线粒体偶联因子6（coupfing factor6，CF6）、细胞色素C水平的变化，探讨其在新生儿败血症中的临床意义。方法以2015年1月至2015年4月湖南省儿童医院新生儿科收治的日龄3～28d内的足月新生儿88例为研究对象，根据感染情况将患儿分为非败血症组（42例）和败血症组（46例）；根据感染严重程度，进一步将非败血症组分为无感染组（20例）、感染致炎症反应组（22例），败血症组分为普通败血症组（31例，无器官功能衰竭）和重症败血症组（15例，有多器官功能衰竭）。所有患儿均在入院后未用抗生素前采集股静脉血，用ELISA法检测入院后血浆CF6、细胞色素C的活性水平，同时检测C一反应蛋白（C—reactive protein，CRP）、降钙素原（procalcitonin，PCT），比较血浆CF6、细胞色素C的变化情况；与传统临床诊断新生儿败血症的非特异性指标（CRP、PCT）进行比较，探讨其敏感度及特异度；对CF6、细胞色素C的活性水平与新生儿危重症评分进行相关性分析。结果（1）入院时败血症组CF6、细胞色素C水平分别为（109．7±8．9）pg／ml和（44．5±4．9）ng／ma，显著高于非败血症组[（46．3±6．0）pg／ml、（31．8±6．7）ng／ml，P均〈0．01]；（2）无感染组、感染致炎症反应组、普通败血症组、重症败血症组CF6水平分别为（32．1±8．9）pg／ml、（59．3±7．2）pg／ml、（79．3±5．9）pg／ml、（172．64-6．1）pg／ml；细胞色素C水平分别为（29．3±8．6）mg/ml、（35．4±4．1）ng／ml、（43．1±5．9）n∥ml、（44．5±5．9）ne,／ml；各组间比较差异有统计学意义（P〈0．01）；（3）受试者工作特征曲线分析显示，CF6、细胞色素C的敏感度和特异度分别为0．761、0．732，0．739、0．714；（4）血浆CF6、细胞色素C与新生儿危重症评分呈负相关（r=-0．599，P〈0．001；r=-0．337，P〈0．01）。CF6、细胞色素C随着病情严重程度的加重而升高。结论新生儿败血症时血浆CF6、细胞色素C水平有升高趋势，其可能与线粒体受损有关。血浆CF6、细胞色素C水平与新生儿败血症病情严重程度具有相关性，对临床有一定指导意义。

Objective To evaluate the levels of plasma coupling factor 6 （CF6） and cytochrome C （Cyt-c） in neonatal sepsis, and to explore the clinical significance in neonatal sepsis. Methods A total of 88 neonates admitted to Hunan Children＇s Hospital from January 2015 to April 2015 were collected. Neonates were divided into non-sepsis group（ n = 42） and sepsis group（ n = 46）. According to the severity of infection, the non-sepsis group was further divided into non-infection group （n = 20 ） and common infection group （n = 22） ; the sepsis group was further divided into general sepsis group （31 cases,no organ failure） and severe sepsis group （ 15 cases, combined with multiple organ failure）. Femoral venous blood was collected in all patients before the use of antibiotics after admission. The levels of Cyt-c and CF6 in plasma were measured by ELISA, and the levels of C-reactive protein （ CRP）, procalcitonin （PCT） were measured. The changes of CF6 and Cyt-c between these groups were compared, and the sensitivity and specificity with the traditional sepsis index （CRP,PCT） were analyzed. The correlation between the levels of CF6 ,Cyt-c and neonatal critical illness score was analyzed. Results （ 1 ） In sepsis group, the levels of CF6 and Cyt-c [ （ 109. 7 ± 8.9 ） pg/ml and （44. 5 ±4. 9） ng/ml] were significantly higher than those in the non-sepsis groupE （46. 3 ±6. 0）pg/ml, （ 31.8 ± 6. 7 ） ng/ml, P 〈 0. 01, respectively 1. （ 2 ） In the non-infection group, common infection group, general sepsis group and severe sepsis group, the levels of CF6 were （ 32. 1 ± 8.9 ） pg/ml, （ 59. 3 ± 7.2 ） pg/ml,（79. 3± 5.9 ） pg/ml, and （ 172. 6 ± 6. 1 ） pg/ml, respectively; the levels of Cyt-c were （ 29. 3 ± 8.6 ） ng/ml, （35.4 ± 4. 1 ） ng/ml, （43.1±5.9） ng/ml, and （44. 5 ± 5. 9 ） ng/ml, respectively. The differences between these groups were significant（ P 〈0. 01 ）. （3）The receiver operating characteristic curve showed that the sen- sitivity and specificity of CF6 were 0. 761,0. 732, and the Cyt-c were 0. 739,0.714. （4）Cyt-C and CF6 were negatively correlated with the neonatal critical illness score（ r = - 0. 599 ,P 〈 0. 001 ; r = - 0. 337 ,P 〈 0. 01 ）. Conclusion The levels of CF6 and Cyt-c increase in neonatal sepsis. The damage of mitochondria may be one of the pathological mechanisms in neonatal sepsis. The levels of CF6 and Cyt-c were closely related to the severity of neonatal sepsis.