脐血调节性T细胞检测在早产儿支气管肺发育不良中的预测价值

The Predictive value of umbilical cord blood regulatory T cells for bronchopulmonary dysplasia in preterm infants

目的探讨脐血调节性T细胞(regulatory T cells,Treg)检测对早产儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)的预测价值.方法前瞻性选择2017年6月至2018年12月深圳市宝安区松岗人民医院新生儿重症监护病房收治的胎龄<32周的早产儿,采集出生时脐血检测Treg数量,根据出院时是否发生BPD分为BPD组和非BPD组.分析两组患儿Treg数量及其在BPD不同程度间的差异.结果最终纳入胎龄<32周的早产儿124例,其中BPD组41例(轻度18例、中度14例、重度9例),胎龄(29.6±1.1)周,出生体重(1128±135)g;非BPD组83例,胎龄(29.8±1.1)周,出生体重(1316±180)g.BPD组出生体重、1 min和5 min Apgar评分低于非BPD组、新生儿呼吸窘迫综合征发生率高于非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<0.001).重度BPD组新生儿机械通气时间及吸氧时间明显长于中度组和轻度组,且中度组机械通气时间长于轻度组,差异均有统计学意义(P<0.001).BPD组脐血Treg数量明显低于非BPD组[(1.43±0.06)×10^5个/ml比(2.57±0.09)×10^5个/ml],差异有统计学意义(P<0.001).多因素Logistic回归分析显示,Treg数量减少是早产儿发生BPD的危险因素(OR=0.000,95%CI 0.000~0.012,P=0.009);脐血Treg数量与BPD严重程度成负相关.受试者工作特征曲线分析脐血Treg预测BPD的最佳临界值为1.95×10^5个/ml,敏感度85.4%,特异度75.9%.结论脐血Treg检测可能对早产儿发生BPD具有早期预测作用.

Objective To study the predictive value of umbilical cord blood regulatory T cells (Treg) for bronchopulmonary dysplasia (BPD) in preterm infants. Method From June 2017 to December 2018, premature infants with gestational age less than 32 weeks admitted to NICU of our hospiatal were prospectively selected. The umbilical cord blood was collected at birth to examine the Treg amount. The infants were assigned into BPD group and non-BPD group according to the diagnosis at discharge. The differences of Treg amount between the two groups and different degrees of BPD were analysed. Result A total of 124 premature infants (GA<32 weeks) were admitted, including 41 cases in BPD group (mild, n=18;moderate, n=14;severe, n=9) and 83 cases in the non-BPD group.The BPD group had GA of (29.6±1.1) weeks and birth weight (BW) of (1 128±135) g. The non-BPD group had GA of (29.8±1.1) weeks and BW of (1 316±180) g. The birth weight, 1min and 5min Apgar scores in BPD group were lower than the non-BPD group (P<0.001). The BPD group had higher incidence of respiratory distress syndrome, longer duration of mechanical ventilation (MV) and oxygen inhalation(P<0.001) than the non-BPD group. The MV duration and oxygen inhalation duration in the severe BPD group were significantly longer than the moderate and mild BPD groups, and the duration in the moderate group was longer than the mild group (P<0.001). The number of Treg in cord blood in the BPD group [(1.43±0.06)×10^5 cells/ml] was significantly lower than the non-BPD group [(2.57±0.09)× 10^5 cells/ml], and the difference was statistically significant (P<0.001). Multivariate Logistic regression analysis showed that a significant decrease in the number of Treg was a risk factor for BPD in premature infants (OR=0.000, 95%CI 0.000 ~ 0.012, P=0.009). The number of Treg in umbilical cord blood was negatively correlated with the severity of BPD. The area under the ROC curve showed that the cut-off value was 1.95×10^5 cells/ml, with Youden index 0.613, sensitivity 85.4% and specificity 75.9%. Conclusion The number of cord blood Treg cells may be a useful biomarker for predicting BPD in premature infants.