血浆脂氧素A4和基质金属蛋白酶9在早产儿支气管肺发育不良中的预测价值

Predictive value of plasma lipoprotein A4 and matrix metalloproteinase 9 for bronchopulmonary dysplasia in premature infants

目的探讨血浆中脂氧素A4(LXA4)和基质金属蛋白酶9(MMP9)的动态变化及对早产儿支气管肺发育不良(BPD)的预测价值。方法选择2018年1—7月入住徐州医科大学附属医院新生儿科32周以下的早产儿50例,根据BPD的诊断标准为BPD组(20例)和非BPD组(30例),采用酶联免疫吸附法(ELISA)检测病儿第1、7、14天血浆中LXA4、MMP9的表达水平。结果生后第1天BPD组和非BPD组血浆LXA4表达水平[(330.4±21.6)比(321.1±35.9)pg/mL],差异无统计学意义(P>0.05);BPD组第7天LXA4水平为(281.8±7.0)pg/mL,第14天LXA4水平为(188.4±5.7)pg/mL,随着时间推移逐渐下降,各时间点均低于非BPD组,不同时间点之间两两比较均差异有统计学意义,非BPD组LXA4水平逐渐上升,于第7天达到峰值(348.6±4.4)pg/mL,后又逐渐下降至第14天的(270.3±5.4)pg/mL,不同时间点之间两两比较均差异有统计学意义(P<0.05);第1天BPD组和非BPD组血浆MMP9表达水平(23.9±3.9)ng/mL比(25.3±2.6)ng/mL,差异无统计学意义(P>0.05),BPD组血浆MMP9水平逐渐上升,且生后第7、14天BPD组血浆MMP9水平[(32.6±3.9)ng/mL、(39.0±2.1)ng/mL]均高于非BPD组[(28.8±2.9)ng/mL、(32.2±3.4)ng/mL],不同时间点之间两两比较差异有统计学意义(P<0.05)。依据BPD组和非BPD组LXA4浓度绘制ROC曲线下面积为0.670(95%可信区间为0.580~0.759),依据BPD组和非BPD组MMP9浓度绘制ROC曲线下面积为0.749(95%可信区间为0.667~0.830)。结论生后7 d检测血浆LXA4和MMP9的表达水平对早产儿支气管肺发育不良有早期预测价值。

Objective To explore the dynamic changes of plasma lipoprotein A4(LXA4)and matrix metalloproteinase 9(MMP9)and their predictive value for bronchopulmonary dysplasia in premature infants.Methods A total of 50 premature infants under 32 weeks admitted to the Department of Neonatology of Xuzhou Medical University from January to July 2008 were selected,and divid ed into the BPD group(20 cases)and non bpd group(30 cases)according to the diagnostic criteria of BPD.The expressions of LXA4 and MMP9 in plasma were detected by ELISA on day 1,7 and 14.Results There was no significant difference in plasma LXA4 expression level between the BPD group and the non BPD group at 1 d after birth[(330.4±21.6)vs.(321.1±35.9)pg/mL,P>0.05].The LXA4 level in the BPD group was(281.8±7.0)pg/mL on the 7th day and(188.4±5.7)pg/mL on the 14th day,which decreased gradually as time went on,and was lower than that in the non BPD group at all time points.The LXA4 level in the non BPD group increased gradually,reaching a peak value(348.6±4.4)pg/mL on the 7th day,and then gradually decreased to(270.3±5.4)pg/mL on the 14th day.There was a statistically significant difference between the two groups at different time points(P<0.05);On the first day,the plasma MMP9 level in the BPD group and non BPD group was(23.9±3.9)ng/mL vs.(25.3±2.6)ng/mL,the difference was not statistically significant(P>0.05).The plasma MMP9 level in the BPD group gradually rised.And the plasma MMP9 levels[(32.6±3.9)ng/mL,(39.0±2.1)ng/mL]in the BPD group at 7 and 14 days after birth were higher than those in the non BPD group[(28.8±2.9)ng/mL,(32.2±3.4)ng/mL],there was a statistically significant difference between the two groups at differ ent time points(P<0.05).The area under the ROC curve calculated according to the concentration of LXA4 in the BPD group and the non BPD group was,0.670(95%confidence interal 0.580 to 0.759).The area under the ROC curve calculated on the basis of MMP9 was 0.749(95%confidence interal 0.667 to 0.830).Conclusion The detection of plasma LXA4 and MMP9 expression on 7th days after birth has an early predictive value for bronchopulmonary dysplasia in premature infants.