早产儿支气管肺发育不良的影响因素及血清IL-33和sST2的预测价值

Influencing factors of bronchopulmonary dysplasia in preterm infants and predictive value of serum IL-33 and sST2

目的分析早产儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)的影响因素,并探讨白细胞介素33(Interleukin 33,IL-33)和可溶型ST2(Soluble ST2,sST2)预测BPD的价值。方法选取2016年6月~2018年6月本院收治的246例早产儿(胎龄28~32w)为研究对象。在出生时采集脐血,出生后7d、14d和21d时采集股静脉血1.5ml,分离血清。用酶联免疫吸附试验法检测血清中IL-33和sST2的表达水平。用Logistic多因素分析和受试者工作特征曲线(ROC)分析血清IL-33和sST2预测BPD发生的价值。结果与健康对照组比较,非BPD组脐血血清IL-33和sST2表达水平明显较高(P均<0.05)。与非BPD组比较,BPD组脐血血清IL-33和sST2表达水平明显较高,并且随着病情严重程度增高而增高(P均<0.05)。BPD组出生时、出生后7d、14d和21d时血清中IL-33和sST2表达水平均高于非BPD组(P均<0.05)。胎龄(OR=0.387)、吸氧时间(OR=1.555)、宫内感染(OR=4.213)、脐血血清中IL-33(OR=3.391)和sST2(OR=3.000)表达水平是早产儿发生BPD的独立影响因素(P均<0.05)。脐血血清IL-33预测早产儿发生BPD的AUC为0.835(95%CI:0.756~0.908),sST2为0.809(95%CI:0.718~0.895),二者联合预测为0.917(95%CI:0.865—0.964),IL-33和sST2预测BPD的最佳临界值分别为91.04pg/ml和69.85pg/ml。结论与健康新生儿和早产非BPD患儿相比,BPD早产儿血清IL-33和sST2表达水平明显升高,早期检测脐血血清中IL-33和sST2的表达水平有助于预测早产儿发生BPD。

Objective:To analyze the influencing factors of bronchopulmonary dysplasia(BPD)in preterm infants,and to explore the value of interleukin-33(IL-33)and soluble ST2(sST2)in predicting BPD.Methods:246 premature infants(gestational age 28-32 weeks)admitted to our hospital from June 2016 to June 2018 were selected as the research objects.Umbilical cord blood was collected at birth,and 1.5ml femoral vein blood was collected at 7d,14d and 21d after birth.The expression levels of IL-33 and sST2 in serum were detected by ELISA.Logistic multivariate analysis and receiver operating characteristic curve(ROC)were used to analyze the value of serum IL-33 and sST2 in predicting BPD.Results:Compared with the healthy control group,the levels of IL-33 and sST2 in serum of non BPD group were significantly higher(P<0.05).Compared with non BPD group,the levels of IL-33 and sST2 in cord blood of BPD group were significantly higher,and increased with the severity of disease(P<0.05).The serum levels of IL-33 and sST2 in BPD group were higher than those in non BPD group at birth,7,14 and 21 days after birth(all P<0.05).Gestational age(OR=0.387),oxygen inhalation time(OR=1.555),intrauterine infection(OR=4.213),and the expression levels of IL-33(OR=3.391)and sST2(OR=3.000)in cord blood were the independent influencing factors of BPD in preterm infants(all P<0.05).The AUC of cord blood serum IL-33 was 0.835(95% CI:0.756-0.908),sST2 was 0.809(95% CI:0.718-0.895),and the combined prediction of IL-33 and sST2 was 0.917(95% CI:0.865-0.964).The optimal critical values of IL-33 and sST2 in predicting BPD were 91.04pg/ml and 69.85pg/ml,respectively.Conclusion:Compared with healthy newborns and preterm non BPD infants,serum IL-33 and sST2 expression levels in BPD preterm infants were significantly higher.Early detection of IL-33 and sST2 expression levels in cord blood serum can help to predict the occurrence of BPD in preterm infants.