早产儿支气管肺发育不良呼吸道分泌物TNF-α、IL-1β、Ang-1的变化与临床预测价值

The changes and clinical value of TNF-α、IL-1β、Ang-1 in the respiratory tract of premature infants with bronchopulmonary dysplasia

目的 :检测早产儿生后不同时期呼吸道分泌物肿瘤坏死因子-α(TNF-α),白细胞介素1β(IL-1β),血管生成素-1(Ang-1)水平,并分析与支气管肺发育不良(BPD)的关系及临床价值。方法 :选取2021年1月~12月期间武汉儿童医院新生儿科收治的98例胎龄≤32周早产儿为研究对象,根据临床氧依赖情况进行BPD诊断及分度。在患儿出24小时内及生后每周采集患儿呼吸道分泌物,使用酶联免疫吸附试验法测试TNF-α、IL-1β和Ang-1水平,同时收集患儿临床资料进行统计分析。结果 :33例BPD患儿中,重度5例,中度11例,轻度17例。BPD患儿胎龄小,体重低,双胎比例高,生后各时间点TNF-α,IL-1β及Ang-1水平均显著高于非BPD组。轻、中和重度BPD患儿IL-1β和Ang-1组间及时间变化趋势较非BPD患儿差异明显。第2周IL-1β水平对中、重度BPD有良好的预测价值,当取值为8.84pg/ml时,敏感度,特异度分别为87.5%,82.4%。结论 :呼吸道炎性因子水平与BPD的发生和严重程度相关,动态测定有助于临床预测及评估。

Objective To detect the level of tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β) and Angiogenesis-1(Ang-1) in respiratory secretions of premature infants at different periods after birth, and to analyze the relationship between these factors and Bronchopulmonary dysplasia(BPD) and its clinical value. Methods A total of 98 preterm infants, with gestational age ≤32 weeks(24-32 weeks, average 29.7±1.7 weeks), who admitted to the Neonatal Department of Wuhan Children’s Hospital from January 2021 to December 2021, were selected as the research subjects. Respiratory secretions were collected by deep sputum aspiration method within 24 hours after birth and in every week, until the BPD was diagnosed at the 4-week after birth. The clinical manifestations of the children were observed until the corrected gestational age reached 36 weeks, when the BPD grading was performed. The levels of TNF-α, IL-1β and Ang-1 in sputum were measured by enzyme-linked immunosorbent assay(ELISA), and clinical data of the children were collected for statistical analysis. Results Of the 98 cases, 33cases were diagnosed as BPD, including 5 cases severe, 11 moderate, and 17 mild. Children with BPD had smaller gestational age, lower body weight, higher proportion of second births, and significantly higher levels of TNF-α, IL-1β and Ang-1 at all postnatal time points than the non-BPD group. Postnatal IL-1β and Ang-1 levels in children with mild, moderate and severe BPD differed significantly at different times and trends compared with those in non-BPD children. Receiver operating curve(ROC) showed that when IL-1β was 18.84 pg/ml in the first week, the sensitivity and specificity for predicting moderate to severe BPD were 87.5% and 82.4%. Conclusion The degree of early lung injury is related to the occurrence and grading of BPD. The level of airway inflammatory factors is valuable for clinical prediction and early intervention.