不同程度新生儿呼吸窘迫综合征患儿血清细胞因子水平的临床分析

Clinical analysis of serum cytokine levels of premature infants with different severity of neonatal respiratory distress syndrome

目的 探讨血清细胞因子[白介素(IL)-1β、IL-6、IL-8和肿瘤坏死因子(TNF)-α)]在不同程度的早产儿新生儿呼吸窘迫综合征(NRDS)中的变化情况,寻找早期判断NRDS严重程度的血清标志物。方法 选取2017年4月至2020年8月在东南大学医学院附属江阴医院新生儿科新生儿重症监护病房(NICU)住院的NRDS早产儿80例为研究对象。根据NRDS诊断标准分为轻症组(30例)、重症组(20例)及对照组(30例),比较三组患儿的临床资料,分析血清细胞因子IL-1β、IL-6、IL-8和TNF-α水平在三组患儿中的变化。结果 三组患儿的IL-8、IL-1β和TNF-α水平比较差异均无统计学意义(P>0.05),三组患儿的IL-6水平比较差异有统计学意义(t=51.790,P<0.05),重症组患儿的IL-6水平均高于轻症组(t=6.737,P<0.05)和对照组(t=9.009,P<0.05),差异均有统计学意义。经Pearson相关分析或Spearman相关分析显示,IL-6水平与多次使用肺表面活性物质(PS)、入院1周内有创通气、合并支气管肺发育不良(BPD)发生、总呼吸支持时间均呈正相关(r分别为0.449、0.576、0.252、0.354,P<0.05)。结论 血清IL-6水平在不同程度早产儿NRDS中表达有差异。在NRDS早产儿中,IL-6水平越高,早期治疗难度越大。早产儿生后早期IL-6水平可能为判断NRDS严重程度的重要生物学指标之一。

Objective To investigate changes in cytokines(IL-1β,IL-6,IL-8 and TNF-α) of different severity of premature infants with NRDS,so as to find out early serum markers for judging severity of NRDS.Methods 80 premature infants who admitted to Neonatal Intensive Care Unit(NICU) of our hospital over a period from April, 2017 to August, 2020 were selected as research subjects, and they were divided into mild group(n=30),severe group(n=20) and control group(n=30) according to diagnostic criteria of NRDS.The clinical data of the premature infants were compared among the three groups.And the changes in serum levels of cytokines IL-1β,IL-6,IL-8 and TNF-α of the premature infants in the three groups were analyzed.Results There was significant difference in serum IL-6 expression level among the three groups(t=51.790,P<0.05),while no significant differences in IL-8,IL-1β and TNF-α were found among the three groups(all P>0.05).The serum IL-6 expression level was higher than that in both the severe group(t=6.737,P<0.05)and the control group(t=9.009,P<0.05),the differences were significant.But there was no significant difference between the mild group and the control group(P>0.05).Pearson correlation analysis or Spearman correlation analysis showed that the expression level of IL-6 of the premature infants was positively correlated with repeated pulmoaveolar surfactant(PS) use and invasive respiratory support within one week of admission, being accompanied with bronchopulmonary dysplasia(BPD) and the total respiratory support time required(r=0.449,0.576,0.252 and 0.354 respectively, all P<0.05).Conclusion The expression of serum IL-6 level varies in premature infants with different severity of NRDS.In those premature infants with NRDS,the higher the serum level of IL-6,the more difficult to treat early.The serum level of IL-6 in the early postnatal period may be one of the important biological indicators for judging the severity of NRDS.