中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2013年
1期
39-43
,共5页
感染%可溶性髓样细胞触发受体-1%白细胞介素-6%白细胞介素-8%肿瘤坏死因子-α%婴儿,新生
感染%可溶性髓樣細胞觸髮受體-1%白細胞介素-6%白細胞介素-8%腫瘤壞死因子-α%嬰兒,新生
감염%가용성수양세포촉발수체-1%백세포개소-6%백세포개소-8%종류배사인자-α%영인,신생
Infection%Soluble form of triggering receptor expressed on myeloid cells-1%Interleukin-6%Interleukin-8%Tumor necrosis factor-α%Infant,newborn
目的 探讨白细胞介素(interleukin,IL)-6、IL-8、肿瘤坏死因子(tumor necrosis factor,TNF)-α、可溶性髓样细胞触发受体(soluble form of triggering receptor expressed on myeloid cells,sTREM)-1在足月新生儿感染中的变化,并比较四者的诊断价值.方法 以上海交通大学附属上海市儿童医院85例足月新生儿为研究对象,根据感染部位及程度分为全身感染组(27例)、局部感染组(28例)和非感染组(30例).应用流式微珠陈列法检测各组患儿IL-6、IL-8、TNF-α水平,应用酶联免疫法测定sTREM-1水平.结果 (1)不同感染组血清IL-6、IL-8、TNF-α、sTREM-1活性水平存在明显差异,四者平均水平均是全身感染组＞局部感染组＞非感染组(P均＜0.05).(2)全身感染组患儿中17例存活,10例死亡,死亡组患儿sTREM-1为(121.64 ±49.31) pg/ml,明显高于存活组[(73.13 ±34.92) pg/ml,P =0.006],但IL-6、IL-8、TNF-α水平,死亡组与存活组比较差异无统计学意义(P均＞0.05).(3) IL-6、IL-8、TNF-α、sTREM-1诊断价值比较:基于受试者工作特征曲线分析,最佳截断值为每个变量同时达到最大的灵敏度和特异度.在截断值sTREM-1 ≥43.75 pg/ml、IL-6≥89.80 pg/ml、IL-8≥569.55 pg/ml及TNF-α≥24.80 pg/ml为阳性标准时,各指标对诊断新生儿感染性疾病的灵敏度分别为85.5％、89.1％、70.1％和69.5％,特异度分别为80.0％、100％、100％和93.3％.各指标的曲线下面积(area under curve,AUC)均＞0.5,其中IL-6(AUC=0.981)＞sTREM-1(AUC=0.868)＞TNF-α(AUC=0.864)＞IL-8(AUC=0.852).sTREM-1与IL-6、IL-8、TNF-α均有相关性(Spearman等级相关系数分别为r=0.532,P＜0.01；r =0.420,P＜0.01；r=0.531,P＜0.01).结论 (1)血清IL-6、IL-8、TNF-α、sTREM-1水平在新生儿感染时均升高；(2)血清sTREM-1水平与预后有关；(3) sTREM-1与IL-6、IL-8、TNF-α有相关性.
目的 探討白細胞介素(interleukin,IL)-6、IL-8、腫瘤壞死因子(tumor necrosis factor,TNF)-α、可溶性髓樣細胞觸髮受體(soluble form of triggering receptor expressed on myeloid cells,sTREM)-1在足月新生兒感染中的變化,併比較四者的診斷價值.方法 以上海交通大學附屬上海市兒童醫院85例足月新生兒為研究對象,根據感染部位及程度分為全身感染組(27例)、跼部感染組(28例)和非感染組(30例).應用流式微珠陳列法檢測各組患兒IL-6、IL-8、TNF-α水平,應用酶聯免疫法測定sTREM-1水平.結果 (1)不同感染組血清IL-6、IL-8、TNF-α、sTREM-1活性水平存在明顯差異,四者平均水平均是全身感染組＞跼部感染組＞非感染組(P均＜0.05).(2)全身感染組患兒中17例存活,10例死亡,死亡組患兒sTREM-1為(121.64 ±49.31) pg/ml,明顯高于存活組[(73.13 ±34.92) pg/ml,P =0.006],但IL-6、IL-8、TNF-α水平,死亡組與存活組比較差異無統計學意義(P均＞0.05).(3) IL-6、IL-8、TNF-α、sTREM-1診斷價值比較:基于受試者工作特徵麯線分析,最佳截斷值為每箇變量同時達到最大的靈敏度和特異度.在截斷值sTREM-1 ≥43.75 pg/ml、IL-6≥89.80 pg/ml、IL-8≥569.55 pg/ml及TNF-α≥24.80 pg/ml為暘性標準時,各指標對診斷新生兒感染性疾病的靈敏度分彆為85.5％、89.1％、70.1％和69.5％,特異度分彆為80.0％、100％、100％和93.3％.各指標的麯線下麵積(area under curve,AUC)均＞0.5,其中IL-6(AUC=0.981)＞sTREM-1(AUC=0.868)＞TNF-α(AUC=0.864)＞IL-8(AUC=0.852).sTREM-1與IL-6、IL-8、TNF-α均有相關性(Spearman等級相關繫數分彆為r=0.532,P＜0.01；r =0.420,P＜0.01；r=0.531,P＜0.01).結論 (1)血清IL-6、IL-8、TNF-α、sTREM-1水平在新生兒感染時均升高；(2)血清sTREM-1水平與預後有關；(3) sTREM-1與IL-6、IL-8、TNF-α有相關性.
목적 탐토백세포개소(interleukin,IL)-6、IL-8、종류배사인자(tumor necrosis factor,TNF)-α、가용성수양세포촉발수체(soluble form of triggering receptor expressed on myeloid cells,sTREM)-1재족월신생인감염중적변화,병비교사자적진단개치.방법 이상해교통대학부속상해시인동의원85례족월신생인위연구대상,근거감염부위급정도분위전신감염조(27례)、국부감염조(28례)화비감염조(30례).응용류식미주진렬법검측각조환인IL-6、IL-8、TNF-α수평,응용매련면역법측정sTREM-1수평.결과 (1)불동감염조혈청IL-6、IL-8、TNF-α、sTREM-1활성수평존재명현차이,사자평균수평균시전신감염조＞국부감염조＞비감염조(P균＜0.05).(2)전신감염조환인중17례존활,10례사망,사망조환인sTREM-1위(121.64 ±49.31) pg/ml,명현고우존활조[(73.13 ±34.92) pg/ml,P =0.006],단IL-6、IL-8、TNF-α수평,사망조여존활조비교차이무통계학의의(P균＞0.05).(3) IL-6、IL-8、TNF-α、sTREM-1진단개치비교:기우수시자공작특정곡선분석,최가절단치위매개변량동시체도최대적령민도화특이도.재절단치sTREM-1 ≥43.75 pg/ml、IL-6≥89.80 pg/ml、IL-8≥569.55 pg/ml급TNF-α≥24.80 pg/ml위양성표준시,각지표대진단신생인감염성질병적령민도분별위85.5％、89.1％、70.1％화69.5％,특이도분별위80.0％、100％、100％화93.3％.각지표적곡선하면적(area under curve,AUC)균＞0.5,기중IL-6(AUC=0.981)＞sTREM-1(AUC=0.868)＞TNF-α(AUC=0.864)＞IL-8(AUC=0.852).sTREM-1여IL-6、IL-8、TNF-α균유상관성(Spearman등급상관계수분별위r=0.532,P＜0.01；r =0.420,P＜0.01；r=0.531,P＜0.01).결론 (1)혈청IL-6、IL-8、TNF-α、sTREM-1수평재신생인감염시균승고；(2)혈청sTREM-1수평여예후유관；(3) sTREM-1여IL-6、IL-8、TNF-α유상관성.
Objective To evaluate and compare the value of interleukin(IL)-6,IL-8,tumor necrosis factor(TNF)-α,and soluble form of triggering receptor expressed on myeloid cells (sTREM)-1 in neonatal infection and detect the relationship between them.Methods Eighty-five full-term newborns who were admitted to the neonatal ward of Shanghai Children's Hospital of Shanghai Jiaotong University were enrolled,according to the locations and severity of infection,the patients were divided into three groups:systemic infection group (n =27),local infection group(n =28),and non-infection group (n =30).The level of plasma sTREM-1 was measured by enzyme-linked immunosorbent assay,and the levels of IL-6,IL-8 and TNF-α were measured using cytometric bead array.Results (1) The levels of sTREM-1,IL-6,IL-8 and TNF-α were significantly higher in infants with systemic infection group than local infection group and non-infection group(P ＜0.05).(2) There were 17 survivors and 10 deaths in systemic infection group,and the level of sTREM-1 in the non-survivor [(121.64 ±49.31) pg/ml] was higher than the survivor[(73.13 ± 34.92) pg/ml,P =0.006].But the levels of IL-6,IL-8 and TNF-α were not statistically significant in the survivor and the death (P ＞ 0.05).(3) Based on the receiver operating characteristic analysis,cutoff values were identified for each variable that maximized both the sensitivity and specificity.These markers were considered positive if sTREM-1 ≥43.75 pg/ml,IL-6 ≥ 89.80 pg/ml,IL-8 ≥569.55 pg/ml and TNF-α ≥ 24.80 pg/ml.Among these indexes,the sensitivities were 85.5％,89.1％,70.1％ and 69.5％ respectively; the specificity were 80.0％,100％,100％ and 93.3％ respectively.Compared the area under curve(AUC) of them,IL-6(AUC =0.981)＞ sTREM-1 (AUC =0.868) ＞ TNF-α (AUC =0.864) ＞ IL-8 (AUC =0.852).sTREM-1 was correlated with IL-6,IL-8 and TNF-α(Spearman coefficient of rank r =0.532,P ＜0.01 ;r =0.420,P ＜0.01 ;r =0.531,P ＜0.01).Conclusion (1) The levels of plasma sTREM-1,IL-6,IL-8 and TNF-α were higher in neonatal infections;(2) sTREM-1 was associated with prognosis; (3) sTREM-1 was correlated with IL-6,IL-8 and TNF-α.
