中国循证儿科杂志
中國循證兒科雜誌
중국순증인과잡지
CHINESE JOURNAL OF EVIDENCE-BASED PEDIATRICS
2010年
2期
130-134
,共5页
蒋思远%曹云%杨毅%陈超%熊曼
蔣思遠%曹雲%楊毅%陳超%熊曼
장사원%조운%양의%진초%웅만
新生儿%感染%血小板活化因子%血小板活化因子乙酰水解酶
新生兒%感染%血小闆活化因子%血小闆活化因子乙酰水解酶
신생인%감염%혈소판활화인자%혈소판활화인자을선수해매
Neonate%Infection%Platelet-activating factor%Platelet-activating factor-acetylhydrolase
目的 检测感染新生儿血浆血小板活化因子(PAF)水平及其乙酰水解酶(PAF-AH)的活性,探讨两者在新生儿感染中的变化及临床意义.方法 以复旦大学附属儿科医院新生儿科病房收治的日龄<30 d的新生儿为研究对象.依据感染部位和程度分为全身感染组、局部感染组及非感染组;依据日龄分为早期新生儿(≤7 d)和晚期新生儿(>7 d).采集研究对象桡动脉血标本,对全身感染组中合并器官功能衰竭的患儿在感染的第1、3、5和7天增加采集桡动脉血标本.测定血浆PAF水平(μg·L~(-1))和PAF-AH活性(μmol·L~(-1)·min~(-1)).分析感染程度、性别、日龄和出生体重对血浆PAF水平和PAF-AH活性的影响,比较不同感染组PAF水平和PAF-AH活性的差异,观察全身感染合并器官功能衰竭患儿血浆PAF水平和PAF-AH活性在病程1～7 d的变化趋势.结果 研究期间共收治247例新生儿,男146例,女101例;平均日龄9.2(1～57 )d;平均胎龄35.85(27～43)周;平均出生体重2 517(906～4 750 )g.全身感染组91例,局部感染组63例,非感染组93例.①新生儿血浆PAF水平与感染程度相关(P=0.000);血浆PAF-AH活性与感染程度及日龄(P均为0.000)相关.②全身感染组血浆PAF水平(9.5±8.1)显著高于局部感染组(5.3±3.2)及非感染组(4.6±3.5).早期新生儿中,全身感染组血浆PAF-AH活性(5.7±2.7)显著低于局部感染组(7.3±2.9) 和非感染组(7.3±2.5).晚期新生儿中,全身感染组血浆PAF-AH活性(7.0±2.5)显著低于局部感染组(9.7±2.2) 和非感染组(9.7±2.7).③全身感染组合并器官功能衰竭的9/12例存活患儿在病程的1～7 d血浆PAF水平呈下降趋势,PAF-AH活性呈上升趋势.3/12例死亡患儿中两者的变化趋势则相反.④全身感染组31/91例确诊败血症患儿中,革兰阴性菌感染者血浆PAF水平(13.1±11.0)显著高于革兰阳性菌感染者(5.4±3.9 ),PAF-AH活性(4.9±2.1)显著低于革兰阳性菌感染者(7.9±2.4 ).结论 新生儿严重感染时血浆PAF水平增高,PAF-AH活性降低,两者的变化趋势与预后相关.
目的 檢測感染新生兒血漿血小闆活化因子(PAF)水平及其乙酰水解酶(PAF-AH)的活性,探討兩者在新生兒感染中的變化及臨床意義.方法 以複旦大學附屬兒科醫院新生兒科病房收治的日齡<30 d的新生兒為研究對象.依據感染部位和程度分為全身感染組、跼部感染組及非感染組;依據日齡分為早期新生兒(≤7 d)和晚期新生兒(>7 d).採集研究對象橈動脈血標本,對全身感染組中閤併器官功能衰竭的患兒在感染的第1、3、5和7天增加採集橈動脈血標本.測定血漿PAF水平(μg·L~(-1))和PAF-AH活性(μmol·L~(-1)·min~(-1)).分析感染程度、性彆、日齡和齣生體重對血漿PAF水平和PAF-AH活性的影響,比較不同感染組PAF水平和PAF-AH活性的差異,觀察全身感染閤併器官功能衰竭患兒血漿PAF水平和PAF-AH活性在病程1～7 d的變化趨勢.結果 研究期間共收治247例新生兒,男146例,女101例;平均日齡9.2(1～57 )d;平均胎齡35.85(27～43)週;平均齣生體重2 517(906～4 750 )g.全身感染組91例,跼部感染組63例,非感染組93例.①新生兒血漿PAF水平與感染程度相關(P=0.000);血漿PAF-AH活性與感染程度及日齡(P均為0.000)相關.②全身感染組血漿PAF水平(9.5±8.1)顯著高于跼部感染組(5.3±3.2)及非感染組(4.6±3.5).早期新生兒中,全身感染組血漿PAF-AH活性(5.7±2.7)顯著低于跼部感染組(7.3±2.9) 和非感染組(7.3±2.5).晚期新生兒中,全身感染組血漿PAF-AH活性(7.0±2.5)顯著低于跼部感染組(9.7±2.2) 和非感染組(9.7±2.7).③全身感染組閤併器官功能衰竭的9/12例存活患兒在病程的1～7 d血漿PAF水平呈下降趨勢,PAF-AH活性呈上升趨勢.3/12例死亡患兒中兩者的變化趨勢則相反.④全身感染組31/91例確診敗血癥患兒中,革蘭陰性菌感染者血漿PAF水平(13.1±11.0)顯著高于革蘭暘性菌感染者(5.4±3.9 ),PAF-AH活性(4.9±2.1)顯著低于革蘭暘性菌感染者(7.9±2.4 ).結論 新生兒嚴重感染時血漿PAF水平增高,PAF-AH活性降低,兩者的變化趨勢與預後相關.
목적 검측감염신생인혈장혈소판활화인자(PAF)수평급기을선수해매(PAF-AH)적활성,탐토량자재신생인감염중적변화급림상의의.방법 이복단대학부속인과의원신생인과병방수치적일령<30 d적신생인위연구대상.의거감염부위화정도분위전신감염조、국부감염조급비감염조;의거일령분위조기신생인(≤7 d)화만기신생인(>7 d).채집연구대상뇨동맥혈표본,대전신감염조중합병기관공능쇠갈적환인재감염적제1、3、5화7천증가채집뇨동맥혈표본.측정혈장PAF수평(μg·L~(-1))화PAF-AH활성(μmol·L~(-1)·min~(-1)).분석감염정도、성별、일령화출생체중대혈장PAF수평화PAF-AH활성적영향,비교불동감염조PAF수평화PAF-AH활성적차이,관찰전신감염합병기관공능쇠갈환인혈장PAF수평화PAF-AH활성재병정1～7 d적변화추세.결과 연구기간공수치247례신생인,남146례,녀101례;평균일령9.2(1～57 )d;평균태령35.85(27～43)주;평균출생체중2 517(906～4 750 )g.전신감염조91례,국부감염조63례,비감염조93례.①신생인혈장PAF수평여감염정도상관(P=0.000);혈장PAF-AH활성여감염정도급일령(P균위0.000)상관.②전신감염조혈장PAF수평(9.5±8.1)현저고우국부감염조(5.3±3.2)급비감염조(4.6±3.5).조기신생인중,전신감염조혈장PAF-AH활성(5.7±2.7)현저저우국부감염조(7.3±2.9) 화비감염조(7.3±2.5).만기신생인중,전신감염조혈장PAF-AH활성(7.0±2.5)현저저우국부감염조(9.7±2.2) 화비감염조(9.7±2.7).③전신감염조합병기관공능쇠갈적9/12례존활환인재병정적1～7 d혈장PAF수평정하강추세,PAF-AH활성정상승추세.3/12례사망환인중량자적변화추세칙상반.④전신감염조31/91례학진패혈증환인중,혁란음성균감염자혈장PAF수평(13.1±11.0)현저고우혁란양성균감염자(5.4±3.9 ),PAF-AH활성(4.9±2.1)현저저우혁란양성균감염자(7.9±2.4 ).결론 신생인엄중감염시혈장PAF수평증고,PAF-AH활성강저,량자적변화추세여예후상관.
Objective To evaluate the relationship between platelet-activating factor(PAF)/platelet-activating factor-acetylhydrolase(PAF-AH) and neonatal infection and to observe the trends of plasma PAF level and PAF-AH activities during the course of infection by measuring plasma PAF levels and PAF-AH activities in neonates with infection.Methods Neonates admitted to the neonatal ward of Children′s Hospital of Fudan University from July to December in 2008 were enrolled. According to the locations and severity of infection, the patients were divided into 3 groups, general infection group, local infection group and non-infection group. Plasma samples of infection groups were taken within 48 h after infection, others were taken during hospitalization period. Besides, plasma samples were taken on the first, third, fifth and seventh day of infection from the neonates who had severe infection with organ dysfunction to observe the trends of plasma PAF levels and PAF-AH activities during the course of infection. The plasma PAF levels were measured by ELISA, and PAF-AH activities were measured using PAF Acetylhydrolase Assay Kit from Cayman Chemical Company.The plasma PAF levels(μg·L~(-1)) and PAF-AH activities(μmol·L~(-1)·min~(-1)) were compared in different groups and the changes of the plasma PAF levels and PAF-AH activities in severe general infection neonates were compared.Results Total 247(146 boys and 101 girls) neonates were enrolled in the study. Average age, gestational age and birth weight were 9.2(1～57)d, 35.85(27～43)weeks and 2 517(906～4 750)g, respectively. General infection group, local infection group and non-infection group included 91,63 and 93 neonates, respectively. ①Multiple linear regression analysis showed that the plasma PAF levels had relation with severity of infection(P=0.000),no relation with sex,gestional age,birth weight and age;The plasma PAF-AH activities had relation with severity of infection and age(both P=0.000),but had no relation with sex,gestational age and birth weight.The plasma PAF-AH activities were lower in early stage neonates than that in late stage neonates.②Mean plasma PAF levels were significantly higher in infants with general infection (9.5±8.1) than those in infants with non-infection group (5.3±3.2)and local infection group (4.6±3.5)(P=0.000). In early stage or late stage neonates, plasma PAF-AH activities of general infection group (5. 7±2.7, 7.0±2.5) were significantly lower than those of non-infection group (7.3±2.9, 9.7±2.2, respectively) and local infection group (7.3±2.5, 9.7±2.7, respectively).③The plasma PAF levels of 9/12 alive children with multiple organ dysfunction in the course of 1-7 d decreased and plasma PAF-AH activities increased.It was opposite in 3/12 deaths.④Infants with sepsis caused by Gram negative bacteria had higher plasma PAF levels and lower PAF-AH activities than those with sepsis caused by Gram positive bacteria (P=0.005).Conclusions Plasma PAF levels were positively correlated and PAF-AH activities were negatively correlated with the severity of infection. Plasma PAF levels and PAF-AH activities showed variations during the course of infection. The trends of variations may be correlated with the prognosis.
