早产儿血清中性粒细胞明胶酶相关脂质运载蛋白和Ⅱ型肺泡细胞表面抗原水平与支气管肺发育不良的关系

Relationship between serum neutrophil gelatinase-associated lipocalin and kerbs von lungren 6 antigen expressions in early preterm after birth and the development of bronchopulmonary dysplasia

目的探讨早产儿生后早期外周血清中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin，NGAL）和Ⅱ型肺泡细胞表面抗原（kerbs von lungren 6 antigen，KL-6）水平与支气管肺发育不良（bronchopulmonary dysplasia，BPD）的关系。 方法前瞻性选取2015年1～12月本院新生儿重症监护室收治的胎龄〈32周、出生体重〈1 500 g生后24 h内入院的早产儿。于生后24 h、7 d、14 d采集静脉血标本，检测降钙素原（procalcitonin，PCT）、血清NGAL、KL-6表达水平，根据早产儿生后28 d是否发生BPD分为BPD组和非BPD组，比较两组早产儿血清PCT、NGAL及KL-6水平的差异。 结果研究期间最终纳入早产儿55例，其中BPD组20例，非BPD组35例。两组性别、胎龄、出生体重差异无统计学意义（P〉0.05）；BPD组新生儿呼吸窘迫综合征比例高于非BPD组，机械通气时间及吸氧时间长于非BPD组，差异有统计学意义（P〈0.05）。两组早产儿生后24 h PCT水平差异无统计学意义（P〉0.05），生后7、14 d BPD组PCT水平高于非BPD组[7 d：（1.5±1.7） ng/ml比（0.4±0.2） ng/ml，14 d：（0.8±0.7） ng/ml比（0.2±0.1） ng/ml]，差异有统计学意义（P〈0.05）；且BPD组与非BPD组7 d和14 d PCT水平均较同组生后24 h降低，差异有统计学意义（P〈0.05）。各时间点BPD组血清NGAL水平均高于非BPD组[24 h：（1.6±0.3） pg/ml比（0.8±0.2） pg/ml，7 d：（2.3±0.5） pg/ml比（0.7±0.2） pg/ml，14 d：（2.5±0.3） pg/ml比（0.8±0.2） pg/ml]，差异有统计学意义（P〈0.05）；且生后7 d和14 d BPD组血清NGAL水平明显高于生后24 h，差异有统计学意义（P〈0.05）。生后24 h两组血清KL-6水平差异无统计学意义（P〉0.05），生后7 d和14 d BPD组血清KL-6水平高于非BPD组[7 d：（1.2±0.2） ng/ml比（0.8±0.1） ng/ml，14 d：（1.3±0.2） ng/ml比（0.8±0.9） ng/ml]，差异有统计学意义（P〈0.05）；且BPD组生后7 d和14 d明显高于生后24 h，差异有统计学意义（P〈0.05）。 结论早产儿合并新生儿呼吸窘迫综合征、长时间机械通气是发生BPD的高危因素，生后早期血清NGAL和KL-6水平升高可能与BPD的发生有关。

ObjectiveTo study the relationship between serum neutrophil gelatinase-associated lipocalin （NGAL）, kerbs von lungren 6 antigen （KL-6） and bronchopulmonary dysplasia （BPD） in preterm infants.MethodFrom Jan.2015 to Dec.2015, preterm infants admitted to NICU of Guangzhou Women and Childrem′s Medical Center with gestational age less than 32 weeks and birth weight less than 1 500 g were enrolled. The serum levels of procalcitonin （PCT）, NGAL and KL-6 protein were detected at 24 h, 7 d and 14 d after birth. At the 28 d after birth, according to the presence of BPD or not, the infants were assigned into BPD group and non-BPD group. The differences of the serum levels of PCT, NGAL and KL-6 between the two groups were compared. ResultA total of 55 cases were included in the study （BPD group 20 cases, non-BPD group 35 cases）. No significant differences existed in gender, birth weight and gestational age between the two groups （P〉0.05）. The incidence of respiratory distress syndrome were siginificantly higher in the BPD group （P〈0.05） and the duration of mechanical ventilation and oxygen therapy were siginifantly longer in the BPD group （P〈0.05）. No significant difference between the two groups in the level of PCT at 24 h after birth （P〉0.05）. The levels of serum PCT at 7 d and 14 d after birth in BPD group were significantly higher than non-BPD group [7 d： （1.5±1.7） ng/ml vs.（0.4±0.2） ng/ml, 14 d： （0.8±0.7） ng/ml vs.（0.2±0.1） ng/ml] （P〈0.001）. The levels of serum NGAL at 24 h, 7 d and 14 d were significantly higher than non-BPD group [24 h： （1.6±0.3） pg/ml vs. （0.8±0.2） pg/ml, 7 d： （2.3±0.5） pg/ml vs.（0.7±0.2） pg/ml, 14 d： （2.5±0.3） pg/ml vs.（0.8±0.2） pg/ml] （P〈0.001）. The levels of serum NGAL at 7 d and 14 d after birth in BPD group were significantly higher than 24 h in BPD group （P〈0.05）. No significant difference between KL-6 at 24 h after birth in BPD group and non-BPD group （P〉0.05）. The levels of serum KL-6 at 7 d and 14 d after birth in BPD group were significantly higher than non-BPD group [7 d： （1.2±0.2） ng/ml vs.（0.8±0.1） ng/ml, 14 d： （1.3±0.2） ng/ml vs.（0.8±0.9） ng/ml] （P〈0.001）. The level of serum KL-6 at 7 d and 14 d after birth in BPD group were significantly higher than 24 h in BPD group （P〈0.05）.ConclusionRespiratory distress syndrome and prolonged mechanical ventilation were risk factors of BPD. The rising of serum NGAL and KL-6 early after birth might be involved in the development of BPD, which had predictive value of BPD.