脐血炎性标志物在新生儿肺部感染性疾病中的应用价值

Application value of umbilical cord blood inflammatory markers in neonatal pulmonary infectious diseases

目的探讨脐血炎性标志物在新生儿肺部感染性疾病中的临床应用价值。方法收集2018年6月至2019年9月在本院妇产科出生且胎龄为34~42周的新生儿脐血。母孕期有感染高危征象,在生后24 h内出现呼吸窘迫并需要呼吸机支持的新生儿为病例组(39例);母孕期无任何感染征象的正常新生儿为对照组(40例)。分别送检中性粒细胞CD64及炎症因子(IL-2R、IL-8、IL-10、TNF-α、IL-6)。病例组再细分为肺水肿组及非肺水肿组,急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)组及非ARDS组。比较各组炎性标志物的水平并绘制ROC曲线及计算曲线下面积(AUC)。结果病例组IL-2R、IL-8、IL-10、TNF-α、IL-6水平较对照组显著升高(P<0.05),两组间CD64水平差异无统计学意义(P>0.05)。肺水肿组TNF-α和IL-6水平较非肺水肿组明显升高(P<0.05);ARDS组TNF-α和IL-2R水平较非ARDS组显著升高(P<0.05)。结论对于有宫内感染高危因素的近足月/足月儿,脐血炎性标志物有望成为其肺部感染的早期预警标志物,其中TNF-α、IL-6和TNF-α、IL-2R分别对早期识别肺水肿和ARDS具有重要临床价值。

Objective To investigate the application value of umbilical cord blood inflammatory markers in neonatal pulmonary infectious diseases. Methods Samples of umbilical cord blood from the women with gestational age between 34 weeks and 42 weeks during delivery in our hospital were enrolled from Jane 2018 to September 2019. Thirty-nine samples were assigned into case group, with the neonates with high risk signs of maternal infection, respiratory distress and respiratory support within 24 h after birth, and another 40 samples from normal neonates without any signs of maternal infection and being healthy after birth were assigned into control group(40 cases). All blood samples were tested for the levels of neutrophils CD64 and inflammatory factors, including IL-2 R, IL-8, IL-10, TNF-α and IL-6. The case group was further divided into pulmonary edema subgroup and non-pulmonary edema subgroup, and acute respiratory distress syndrome(ARDS) subgroup and non-ARDS subgroup. The levels of inflammatory markers were analyzed and compared between the groups and subgroups. Receiver operating characteristic(ROC) curve analysis and the area under the curve(AUC) were used to assess their values. Results The levels of IL-2 R, IL-8, IL-10, TNF-α and IL-6 were significantly higher in the case group than the control group(P<0.05), but no obvious difference was seen in the level of CD64 between them(P>0.05). The levels of TNF-α and IL-6 in the pulmonary edema subgroup were notably higher than those in the non-pulmonary edema subgroup(P<0.05). The ARDS subgroup had statistically higher TNF-α and IL-2 R levels when compared with the non-ARDS subgroup(P<0.05). Conclusion For the near-term and full-term neonates with high risk of intrauterine infection, inflammatory markers in the umbilical cord blood are expected to be early warning markers of neonatal pulmonary infectious diseases. TNF-α and IL-6 have clinical value in the early estimation of pulmonary edema, and TNF-α and IL-2 R have the potential for ARDS.