肺部超声与IRF5和IL-10基因多态性对早产儿肺部感染的诊断价值

Diagnostic value of pulmonary ultrasound and IRF5 and IL-10 gene polymorphisms in pulmonary infection of premature infants

目的探讨肺部超声、干扰素调节因子5(IRF5)和白细胞介素(IL)-10基因多态性对早产儿肺部感染的预测价值及患儿病原菌分布、炎症指标。方法选取2020年12月-2023年5月青岛大学附属青岛市海慈医院收治的110例肺部感染早产儿为研究组,120例无感染早产儿为对照组;比较两组临床资料、肺部超声评分、IRF5基因多态性及IL-10基因多态性,采用受试者工作特征(ROC)曲线分析肺部超声、IRF5和IL-10基因多态性对早产儿肺部感染的预测价值,并统计病原菌分布特点,比较两组炎症指标。结果研究组胎膜早破的占比高于对照组,肺部超声评分低于对照组(P<0.05);研究组IRF5基因TT基因型及T等位基因的频率分别为57.27%、71.82%,均高于对照组的36.67%、51.25%(P<0.05);研究组IL-10基因AA基因型及A等位基因的频率分别为55.45%、74.09%,均高于对照组的35.00%、60.83%(P<0.05);肺部超声、IRF5和IL-10基因多态性及联合检测预测早产儿肺部感染的曲线下面积(AUC)为0.886,敏感度为74.55%,特异度为89.17%;110例研究组患儿病毒感染占比为21.82%,细菌感染占比为78.18%,其中细菌感染占比较高,主要为大肠埃希菌、表皮葡萄球菌;研究组血清IL-6、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C-反应蛋白(CRP)水平均高于对照组,血清IL-10水平低于对照组(P<0.05)。结论胎膜早破、肺部超声评分及血清IL-6、TNF-α、PCT、CRP、IL-10水平变化可能与早产儿肺部感染的发生存在一定联系,肺部超声、IRF5和IL-10基因多态性联合检测对早产儿肺部感染的预测价值较高,而感染类型以细菌感染为主,临床可据此对早产儿肺部感染做出尽早诊断并针对性给予抗菌治疗。

OBJECTIVE To investigate the predictive value of pulmonary ultrasound,interferon regulatory factor 5(IRF5)and interleukin(IL)-10 gene polymorphisms for pulmonary infection in preterm infants and the distribution of pathogenic bacteria and inflammatory indicators.METHODS A total of 110 premature infants with pulmonary infection admitted to our hospital from Dec 2020 to May 2023 were recruited as the research group,and 120 premature infants without infection were selected as the control group.The clinical data,lung ultrasound scores,gene polymorphisms of IRF5 and IL-10 genes were compared.The predictive value of lung ultrasound and gene polymorphisms of IRF5 and IL-10 in premature infant lung infection were evaluated by receiver operating characteristic(ROC)curves.The distribution of pathogenic bacteria was analyzed and the inflammatory indicators between the two groups were compared.RESULTS The proportion of premature rupture of membranes in the research group was higher than that in the control group,while the score of lung ultrasound was lower than that in the control group(P<0.05).The frequencies of the TT genotype and T allele of the IRF5 gene in the research group were 57.27%and 71.82%,respectively,which were higher than 36.67%and 51.25%in the control group(P<0.05).The frequencies of AA genotype and A allele of the IL-10 gene in the research group were 55.45%and 74.09%,respectively,which were higher than 35.00%and 60.83%in the control group(P<0.05).The area under the curve(AUC)of combined detection of lung ultrasound,IRF5 and IL-10 gene polymorphisms for predicting pulmonary infection in premature infants was 0.886,with the sensitivity and specificity of 74.55%and 89.17%,respectively.In the study group of 110 cases,virus infection accounted for 21.82%,bacterial infection accounted for 78.18%,of which bacterial infection accounted for a relatively high proportion,mainly Escherichia coli and Staphylococcus epidermidis.The serum levels of IL-6 and tumor necrosis factorα(TNF-α),procalcitonin(PCT)and C-reactive protein(CRP)in the research group were higher than those in the control group,while the level of serum IL-10 was lower in the control group(P<0.05).CONCLUSION Premature rupture of membranes,pulmonary ultrasound scores,and the variation levels of serum IL-6 and TNF-α,PCT,CRP and IL-10 may be related to the occurrence of pulmonary infection in premature infants,The combined detection of lung ultrasound,IRF5 and IL-10 gene polymorphisms have high predictive value in lung infection of preterm infants,and the infection was mainly caused by bacteria.Therefore,early diagnosis of pulmonary infection in premature infants can be made and targeted antimicrobial treatment can be given.