MBL基因多态性与新生儿呼吸窘迫综合征患儿感染风险的关联

Relationship between MBL gene polymorphisms and infection risk in neonates with respiratory distress syndrome

目的 探究甘露糖结合凝集素(MBL)基因多态性与新生儿呼吸窘迫综合征(NRDS)患儿感染风险的关联性。方法 选取2018年6月-2020年3月河北北方学院附属第一医院收治的100例合并感染疾病NRDS患儿作为疾病组,另选取同期分娩的非感染性疾病NRDS患儿53例作为对照组,利用聚合酶链反应(PCR)和测序法对两组患儿进行MBL基因检测,统计治疗前后血浆MBL、超敏C-反应蛋白(hs-CRP)水平,利用受试者工作曲线(ROC)分析MBL对NRDS感染评估的价值。结果 疾病组MBL基因启动子区-221位点G等位基因频率高于对照组,+4位点T等位基因频率、外显子+230位点G等位基因频率低于对照组(P<0.05)。治疗前疾病组血浆MBL水平低于对照组、hs-CRP水平高于对照组(P<0.05);治疗7 d后,疾病组血浆MBL差值低于对照组,hs-CRP差值高于对照组(P<0.05)。ROC曲线分析显示,血浆MBL、hs-CRP二者联合诊断NRDS患儿感染的AUC为0.901,高于MBL和hs-CRP单独诊断的AUC,此时血浆MBL、hs-CRP的截断点分别为633.85 ng/ml、75.81 mg/L。结论 NRDS患儿MBL基因+4、-221、+230位点的多态性改变与感染性疾病的发生相关,感染性疾病NRDS患儿的血浆MBL水平降低,MBL联合hs-CRP对NRDS患儿的感染风险具有较高评估价值。

OBJECTIVE To explore the correlation between DNA polymorphisms of mannose binding lectin(MBL) gene and infection risk in children with neonatal respiratory distress syndrome(NRDS). METHODS A total of 100 children with NRDS and infectious diseases admitted to the hospital from Jun 2018 to Mar 2020 were enrolled in the disease group, another 53 NRDS children without infectious diseases during the same period were in the control group. Detection of MBL gene was conducted in both groups by polymerase chain reaction(PCR) and sequencing method. The levels of MBL and plasma C-reactive protein(hs-CRP) before and after treatment were analyzed. Receiver operating characteristic(ROC) curves was used to evaluate the value of MBL for NRDS infection diagnosis. RESULTS G allele frequency of MBL gene promoter at at-221 locus, T allele frequency at +4 locus, and G allele frequency of exon at +230 locus in the disease group were significantly higher than those in the control group(P<0.05). The plasma MBL level in the disease group was significantly lower than that in the control group, while the level of hs-CRP was significantly higher than that in the control group(P<0.05). After 7 days of treatment, the difference of plasma MBL was significantly higher than that in the control group, while the difference of hs-CRP was significantly lower than that in the control group(P<0.05). ROC curve analysis showed that AUC of the combination of plasma MBL and hs-CRP for the diagnosis of infection in NRDS children was 0.901, higher than that of MBL and hs-CRP alone. The cut-off values of plasma MBL and hs-CRP were 633.85 ng/ml and 75.81 mg/L, respectively. CONCLUSION The DNA polymorphism of MBL gene at +4,-221 and +230 loci in NRDS children are related to the occurrence of infectious diseases. The level of plasma MBL is decreased in NRDS children with infectious diseases. The combination of MBL and hs-CRP has high evaluation value for the diagnosis of infection in NRDS children.