中性粒细胞明胶酶相关脂质运载蛋白、白细胞介素33、肿瘤坏死因子α对非常早产儿支气管肺发育不良的早期预测作用

Role of neutrophils gelatinase-associated lipid delivery protein, interleukin-33 and tumor necrosis factor-α in the early prediction of bronchopulmonary dysplasia in very premature infants

目的研究血清中性粒细胞明胶酶相关质运载蛋白(NGAL)、白介素33(IL-33)、肿瘤坏死因子α(TNF-α)对非常早产儿支气管肺发育不良(BPD)的早期预测作用。方法选取安徽医科大学附属妇幼保健院2018年3月-2019年9月收治的非常早产儿,根据诊断标准分为BPD组和非BPD组。分别检测生后第1、14、28天血清IL-33、TNF-α和NGAL的水平,进行比较分析;并制作受试者工作特征曲线(ROC),判断各个指标早期预测效能。结果 1)共纳入非常早产儿66例,BPD组25例,发生率37.9%,其中轻度15例,中度8例,重度2例;2)不同时间段BPD组血清IL-33、TNF-α和NGAL水平均明显高于非BPD组,差异均有统计学意义(P<0.05),且三者在出生后14 d内的表达水平逐渐升高(P<0.05);3)重度BPD组患儿在第14、28天血清IL-33的表达水平明显高于轻、中度BPD患儿,差异有统计学意义(F=8.220、15.763,P<0.05);4)ROC曲线显示NGAL(第1天)、IL-33(第1天)、TNF-α(第1天)、NGAL(第14天)、IL-33(第14天)、TNF-α(第14天)AUC值分别为0.768、0.752、0.760、0.875、0.978、0.975。结论 IL-33、NGAL、TNF-α均可早期预测BPD的发生,且在生后第1天NGAL早期预测效能最高,第14天IL-33预测效能最高,IL-33还可能是作为评估BPD严重程度的一项指标。

Objective To explore the role of serum neutrophil gelatinase-associated carrier protein(NGAL), interleukin 33(IL-33), and tumor necrosis factor alpha(TNF-α) in the early prediction of bronchopulmonary dysplasia(BPD) in very preterm infants. Methods The very premature infants admitted in Maternal and Child Health Hospital of Anhui Medical University from March 2018 to September 2019 were enrolled in this study and were divided into BPD group and non-BPD group according to the diagnostic criteria.The serum levels of IL-33, TNF-α and NGAL on the 1 st, 14 th and 28 th day after birth were tested for comparative analysis, and receiver operating characteristic(ROC) curves were prepared to obtain early predictive efficacy of various indicators. Results 1) A total of 66 very premature infants were included, of whom 25 cases(37.9%) were in the BPD group, including 15 cases of mild BPD, 8 cases of moderate BPD, and 2 cases of severe BPD.2) The serum levels of IL-33, TNF-α and NGAL in the BPD group at different time periods were significantly higher than those in the non-BPD group(P<0.05), and the expression levels of the three indicators gradually increased during 14 days after birth(P<0.05).3) Children in severe BPD group had significantly higher levels of serum IL-33 on the 14 th days and 28 th days after birth than those with mild to moderate BPD(F=8.220, 15.763, P<0.05).4) ROC curve showed that the areas under curve(AUC) of serum levels of NGAL, IL-33, TNF-α on the 1 st and 14 th day after birth were 0.768, 0.752, 0.760, 0.875, 0.978 and 0.975, respectively. Conclusions IL-33, NGAL, and TNF-α are all early predictors of BPD, with the highest prediction efficiency of NGAL level on the 1 st day after birth, and highest prediction efficiency of IL-33 level on the 14 th day.Moreover, IL-33 may also be used as an indicator to assess the severity of BPD.