中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
18期
1425-1427
,共3页
夏世文%周茜茜%胡玉莲%祝华平%李宁%韩代成%付春花%张漪%王慧%刘红艳%余晶%陈样%张佩
夏世文%週茜茜%鬍玉蓮%祝華平%李寧%韓代成%付春花%張漪%王慧%劉紅豔%餘晶%陳樣%張珮
하세문%주천천%호옥련%축화평%리저%한대성%부춘화%장의%왕혜%류홍염%여정%진양%장패
宫内感染%绒毛膜羊膜炎%炎性因子%脑损伤%婴儿,早产
宮內感染%絨毛膜羊膜炎%炎性因子%腦損傷%嬰兒,早產
궁내감염%융모막양막염%염성인자%뇌손상%영인,조산
Intrauterine infection%Chorioamnionitis%Cytokine%Preterm brain injury%Preterm,infant
目的：探讨宫内感染早产儿血清及脑脊液中炎性因子与脑损伤的关系。方法2012年8月至2013年8月湖北省妇幼保健院新生儿科收治的本院出生的胎龄≤32周早产儿,存在宫内感染高危因素且合并早发型脓毒症患儿51例,存活46例。根据颅脑超声及MRI检查分为颅脑异常组(包括颅内出血和脑白质损伤)18例和颅脑正常组28例。检测出生12 h内血清、出生72 h内脑脊液中白细胞介素(IL)-6、IL-1β及肿瘤坏死因子-α( TNF-α)水平。采用t检验、χ2检验比较组间炎性因子的差异,脑损伤的高危因素采用Logistic回归分析。结果颅脑异常组患儿其孕母临床诊断绒毛膜羊膜炎的比例[44.44%(8/18例)比14.29%(4/28例),χ2=5.168,P=0.038]和外周血白细胞计数[(11.51±9.03)×109/L比(6.95±5.64)×109/L,t=-2.107,P=0.041]高于颅脑正常组。颅脑异常组患儿血清 IL-6和脑脊液IL-6、IL-1β、TNF-α水平分别为(44.83±16.31) ng/L、(51.85±15.65) ng/L、(11.95±2.58) ng/L和(193.11±67.25) ng/L,较颅脑正常组[分别为(36.83±8.76) ng/L、(42.56±12.89) ng/L、(10.26±2.91) ng/L和(160.56±29.02) ng/L]升高,差异有统计学意义(t=-2.687、-2.250、0.269、-2.243,P=0.010、0.029、0.044、0.030)。孕母绒毛膜羊膜炎、血清TNF-α及脑脊液IL-6水平升高是引起颅脑异常的危险因素(P=0.014、0.031、0.047)。结论宫内感染时早产儿血清及脑脊液中炎性因子水平升高可能增加早产儿脑损伤的发生风险。
目的：探討宮內感染早產兒血清及腦脊液中炎性因子與腦損傷的關繫。方法2012年8月至2013年8月湖北省婦幼保健院新生兒科收治的本院齣生的胎齡≤32週早產兒,存在宮內感染高危因素且閤併早髮型膿毒癥患兒51例,存活46例。根據顱腦超聲及MRI檢查分為顱腦異常組(包括顱內齣血和腦白質損傷)18例和顱腦正常組28例。檢測齣生12 h內血清、齣生72 h內腦脊液中白細胞介素(IL)-6、IL-1β及腫瘤壞死因子-α( TNF-α)水平。採用t檢驗、χ2檢驗比較組間炎性因子的差異,腦損傷的高危因素採用Logistic迴歸分析。結果顱腦異常組患兒其孕母臨床診斷絨毛膜羊膜炎的比例[44.44%(8/18例)比14.29%(4/28例),χ2=5.168,P=0.038]和外週血白細胞計數[(11.51±9.03)×109/L比(6.95±5.64)×109/L,t=-2.107,P=0.041]高于顱腦正常組。顱腦異常組患兒血清 IL-6和腦脊液IL-6、IL-1β、TNF-α水平分彆為(44.83±16.31) ng/L、(51.85±15.65) ng/L、(11.95±2.58) ng/L和(193.11±67.25) ng/L,較顱腦正常組[分彆為(36.83±8.76) ng/L、(42.56±12.89) ng/L、(10.26±2.91) ng/L和(160.56±29.02) ng/L]升高,差異有統計學意義(t=-2.687、-2.250、0.269、-2.243,P=0.010、0.029、0.044、0.030)。孕母絨毛膜羊膜炎、血清TNF-α及腦脊液IL-6水平升高是引起顱腦異常的危險因素(P=0.014、0.031、0.047)。結論宮內感染時早產兒血清及腦脊液中炎性因子水平升高可能增加早產兒腦損傷的髮生風險。
목적：탐토궁내감염조산인혈청급뇌척액중염성인자여뇌손상적관계。방법2012년8월지2013년8월호북성부유보건원신생인과수치적본원출생적태령≤32주조산인,존재궁내감염고위인소차합병조발형농독증환인51례,존활46례。근거로뇌초성급MRI검사분위로뇌이상조(포괄로내출혈화뇌백질손상)18례화로뇌정상조28례。검측출생12 h내혈청、출생72 h내뇌척액중백세포개소(IL)-6、IL-1β급종류배사인자-α( TNF-α)수평。채용t검험、χ2검험비교조간염성인자적차이,뇌손상적고위인소채용Logistic회귀분석。결과로뇌이상조환인기잉모림상진단융모막양막염적비례[44.44%(8/18례)비14.29%(4/28례),χ2=5.168,P=0.038]화외주혈백세포계수[(11.51±9.03)×109/L비(6.95±5.64)×109/L,t=-2.107,P=0.041]고우로뇌정상조。로뇌이상조환인혈청 IL-6화뇌척액IL-6、IL-1β、TNF-α수평분별위(44.83±16.31) ng/L、(51.85±15.65) ng/L、(11.95±2.58) ng/L화(193.11±67.25) ng/L,교로뇌정상조[분별위(36.83±8.76) ng/L、(42.56±12.89) ng/L、(10.26±2.91) ng/L화(160.56±29.02) ng/L]승고,차이유통계학의의(t=-2.687、-2.250、0.269、-2.243,P=0.010、0.029、0.044、0.030)。잉모융모막양막염、혈청TNF-α급뇌척액IL-6수평승고시인기로뇌이상적위험인소(P=0.014、0.031、0.047)。결론궁내감염시조산인혈청급뇌척액중염성인자수평승고가능증가조산인뇌손상적발생풍험。
Objective To evaluate the relationship between the cytokine levels in the serum and cerebrospinal fluid and the brain injury in preterm infants. Methods From August of 2012 to August of 2013,51 preterm infants were included and 46 infants were survived. All of them were born at the Maternal and Child Hospital of Hubei Pro-vince,with GA≤32 weeks and high risk factors of intrauterine infection and suffering from early onset sepsis. Ac-cording to the screening findings of cerebral ultrasound and/or MRI,the infants were divided into normal group(n=28) and abnormal groups(n=18) with intracranial hemorrhage or white matter damage. The levels of interleukin(IL)-6,IL-1β and tumor necrosis factor-α( TNF-α) in the serum within 12 hours after birth and in cerebrospinal fluid within 72 hours after birth were investigated. The differences in cytokines between two groups were compared with t-test and Chi-square test,and high risk factors of brain injury were analyzed by Logistic regression models. Results The ab-normal group had higher incidence of clinical maternal chorioamnionitis[44. 44%(8/18 cases) vs 14. 29%(4/28 ca-ses),χ2=5.168,P=0.038] and higher white blood cell count[(11.51±9.03)×109/L vs(6.95±5.64)×109/L,t=-2. 107,P=0. 041]. In the abnormal group,the levels of serum IL-6 [(44. 83±16. 31) ng/L],and IL-6,IL-1βand TNF-αin cerebrospinal fluid [(51. 85±15. 65) ng/L,(11. 95±2. 58) ng/L and(193. 11±67. 25) ng/L] were higher than those in the normal group[(36.83±8.76) ng/L,(42.56±12.89) ng/L,(10.26±2.91) ng/L and(160.56± 29. 02) ng/L,respectively] with the statistical difference(t=-2. 687,-2. 250,0. 269,-2. 243,P=0. 010,0. 029,0. 044, 0. 030). Maternal chorioamnionitis,higher serum TNF-αand cerebrospinal fluid IL-6 were high risk factors for brain in-jury(P=0. 014,0. 031,0. 047). Conclusion Increased systemic and cerebrospinal fluid cytokine levels are possibly re-lated to the preterm brain injury when intrauterine infection occurred.
