早发型败血症早产儿脐血VDBP、25-(OH)D、PCT及IL-6水平变化

Changes of cord blood VDBP, 25-(OH)D, PCT and IL-6 levels in premature infants with early-onset septicemia

目的探讨早发型败血症(EOS)早产儿脐血维生素D结合蛋白(VDBP)、25-羟基维生素D[25-(OH)-D]、降钙素原(PCT)、白细胞介素-6(IL-6)水平检测意义。方法选取232例早产儿,根据是否发生EOS分为EOS组(n=100)和对照组(n=132),均检测脐动脉血及出生后72 h内外周静脉血VDBP、25-(OH)-D、PCT、IL-6水平。EOS组并于抗感染治疗10～14 d后,再次检测上述指标。结果与对照组相比,EOS组脐血及外周血VDBP、25-(OH)D水平明显降低(P <0.05),PCT、IL-6水平明显增高(P <0.05)。经抗感染治疗后,EOS组VDBP、25-(OH)D较出生后72 h明显增高(P <0.05),PCT、IL-6明显降低(P <0.05)。ROC曲线分析显示,脐血VDBP、25-(OH)D、PCT、IL-6预测EOS曲线下面积分别为0.784、0.803、0.836、0.851,分别以54.42 ng/ml、24.29 ng/ml、112.38 pmol/L、25.21 pg/ml为临界值,敏感度与特异度依次为78.3%和81.4%、82.5%和79.2%、86.2%和76.3%、89.1%和84.5%。结论 EOS早产儿脐血VDBP、25-(OH)D显著降低,PCT、IL-6显著增高,4项指标对早产儿EOS早期诊断及疗效评价均有重要价值。

Objective To explore the significance of determination of the levels of vitamin D binding protein (VDBP), 25-hydroxyvitamin D [25-(OH)-D], procalcitonin (PCT) and interleukin-6 (IL-6) in the cord blood of premature infants with early-onset septicemia (EOS). Methods A total of 232 premature infants were divided into an EOS group (n=100) and a control group (n=132) according to whether EOS occurred. The levels of VDBP, 25-(OH)-D, PCT and IL-6 in the umbilical artery blood and peripheral venous blood within 72 hours after the birth were detected. After 10-14 days of anti-infection treatment, the above indexes were detected again in the EOS group. Results Compared with the control group, the levels of VDBP and 25-(OH)D in cord blood and peripheral blood in the EOS group were significantly lower (P < 0.05), while the levels of PCT and IL-6 were significantly higher (P < 0.05). After anti-infection treatment, VDBP and 25-(OH)D in the EOS group increased significantly compared with those determined 72 hours after the birth (P < 0.05), while PCT and IL-6 decreased significantly (P < 0.05). ROC curve analysis showed that the areas under the predicted the EOS curve of cord blood VDBP, 25-(OH)D, PCT and IL-6 were 0.784, 0.803, 0.836 and 0.851, respectively. The critical values were 54.42 ng/ml, 24.29 ng/ml, 112.38 pmol/L and 25.21 pg/ml, and the sensitivity and specificity were 78.3% and 81.4%, 82.5% and 79.2%, 86.2% and 76.3%, and 89.1% and 84.5%, respectively. Conclusion VDBP and 25-(OH)D in the cord blood of premature infants with EOS decrease significantly, and PCT and IL-6 increase significantly. The four indicators have important value in early diagnosis and evaluation of the curative effect on EOS in premature infants.