诱导痰CTGF mRNA、炎性因子及肺功能与呼吸窘迫综合征早产儿危险分级及预后的相关性分析

Correlation analysis of induced sputum CTGF mRNA,inflammatory factors and pulmonary function with risk classification and prognosis of premature infants with respiratory distress syndrome

目的:探讨诱导痰CTGF mRNA、炎性因子及肺功能与呼吸窘迫综合征早产儿危险分级及预后的相关性,并分析影响患儿预后的主要因素。方法:80例呼吸窘迫综合征早产儿根据病情轻重分为轻度组(n=28)、中度组(n=38)及重度组(n=14),根据患儿预后状况划分为预后良好组(n=56)及预后不良组(n=24)。检测所有患儿诱导痰中CTGF mRNA、炎性因子[转化生长因子β1(TGF-β1)、肿瘤坏死因子(TNF-α)及白细胞介素6(IL-6)]及肺功能[达峰时间(TPTEF)、达峰容积比(VPEF/VE)及呼吸峰流速(PEF)],并分析各项指标相关性,采用受试者工作曲线(ROC)下面积(AUC)评价各项指标对患儿预后不良的评估价值,采用Logistics多因素分析影响患儿预后主要因素。结果:CTGF mRNA水平及诱导痰TGF-β1、TNF-α和IL-6蛋白在重度组、中度组及轻度组依次降低,差异有统计学意义(P<0.05);轻度组、中度组及重度组TPTHE、VPEF/VE及PEF水平依次降低,差异有统计学意义(P<0.05);预后良好组与预后不良组相比,CTGF mRNA及诱导痰TGF-β1、TNF-α及IL-6蛋白降低(P<0.05),TPTHE、VPEF/VE及PEF升高(P<0.05);单因素分析结果显示,预后良好组CTGF mRNA、TGF-β1、TNF-α、IL-6、TPTHE、VPEF/VE、PEF及胎龄与预后不良组相比均有统计学差异(P<0.05);CTGF mRNA及诱导痰TGF-β1、TNF-α及IL-6蛋白与患儿病情严重程度均呈正相关(P<0.05),TPTHE、VPEF/VE及PEF与患儿病症程度呈负相关(P<0.05);Logistics分析结果得出,TGF-β1、TNF-α、IL-6及胎龄为影响患儿预后的主要因素。结论:诱导痰中CTGF mRNA、TGF-β1、TNF-α、IL-6、TPTHE、VPEF/VE及PEF不仅可较好评估患呼吸窘迫综合征早产儿病症危险程度,亦可用于对患儿不良预后进行合理预测,具备较高临床应用价值。

Objective:To investigate the correlation of induced sputum CTGF mRNA,inflammatory factors and pulmonary function with risk classification and prognosis of premature infants with respiratory distress syndrome,and to analyze the main factors affecting the prognosis of children.Methods:A total of 80 premature infants with respiratory distress syndrome were selected and divided into mild group(n=28),moderate group(n=38)and severe group(n=14)according to the severity of the disease,at the same time,according to the prognosis of the children,they were divided into a good prognosis group(n=56)and a poor prognosis group(n=24).The induced sputum CTGF mRNA,inflammatory factors[human transforming growth factorβ1(TGF-β1),tumor necrosis factor(TNF-α)and interleukin 6(IL-6)]and pulmonary function[peak time(TPTEF),peak volume ratio(VPEF/VE)and peak expiratory flow(PEF)]were detected,and analyze the correlation of each index,and use receiver operating curve(ROC)and area under the curve(AUC)to evaluate the value of each index for poor prognosis of children,multivariate logistic analysis was used to analyze the main factors affecting the prognosis of children.Results:Comparison of CTGF mRNA,TGF-β1,TNF-αand IL-6 between groups,the levels from high to low were severe group,moderate group and mild group(P<0.05),compared with TPTHE,VPEF/VE and PEF groups,the levels from high to low were mild group,moderate group and severe group(P<0.05).Compared with the poor prognosis group,the good prognosis group had lower levels of CTGF mRNA,TGF-β1,TNF-αand IL-6,and higher TPTHE,VPEF/VE and PEF(P<0.05).Spearman correlation analysis showed that CTGF mRNA,TGF-β1,TNF-αand IL-6 were positively correlated with the degree of disease in children(P<0.05),TPTHE,VPEF/VE and PEF were negatively correlated with the degree of disease in children(P<0.05).The results of logistic analysis showed that TGF-β1,TNF-α,IL-6 and gestational age were the main factors affecting the prognosis of children.Conclusion:Induced sputum CTGF mRNA,TGF-β1,TNF-α,IL-6,TPTHE,VPEF/VE and PEF can not only better assess the risk of premature infants suffering from respiratory distress syndrome,but also be used to reasonably predict the poor prognosis of children,with high application value.