早产儿视网膜病血清血管内皮生长因子色素上皮衍生因子的检测和临床意义  

The changes and significance of serum VEGF and PEDF levels in premature and ROP infants

作　　者：朱丹[1,2] 陈超[1] 

机构地区：[1]复旦大学附属儿科医院,卫生部新生儿疾病重点实验室,上海200032 [2]上海交通大学附属第一人民医院儿科,上海200080

出　　处：《中国循证儿科杂志》2008年第1期27-32,共6页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的观察早产儿生后血清血管内皮生长因子(VEGF)和色素上皮衍生因子(PEDF)水平的动态变化,为早期诊断及预测早产儿视网膜病(ROP)提供依据。方法从2006年6月至2007年1月复旦大学附属儿科医院新生儿病房的早产儿中按入选标准和排除标准确认研究对象。将出生体重≤2000g或胎龄≤34周的患儿进行ROP筛查,将发生ROP患儿作为ROP组;选取与ROP组胎龄和出生体重相匹配的早产儿作为ROP对照组。将未发生ROP的早产儿根据胎龄分为<32周,～33+6周和～36+6周3个胎龄组。所有入选早产儿生后第7、14、21、28和35天分别进行采血,分离血清,经ELISA法检测血清VEGF和PEDF的水平。采用SPSS13.0中混合线性模型-重复数据测量、相关性分析、t检验和单变量方差分析法进行数据分析。结果入选的早产儿共170例,其中6例在生后14d内自动出院失访而排除,11例发生ROP。未发生ROP的153例早产儿中,<32周54例,～33+6周48例,～36+6周51例。各胎龄组血清VEGF水平随日龄的增长而下降(r=-0.167,P=0.000),与第7天比较,差异有统计学意义(第14天,P=0.010;第21天,P=0.000),而自21d起基本保持稳定;血清PEDF水平在生后14d内变化无统计学意义(P=0.713),14d后随日龄的增长而升高(r=0.287,P=0.000),与第7天比较,差异有统计学意义(第21天,P=0.008;第28天,P=0.001;第35天,P=0.000)。胎龄对VEGF和PEDF水平的影响较出生体重显著,胎龄越小,生后血清VEGF和PEDF水平越高,在出生体重的协同作用下,胎龄与VEGF和PEDF水平均呈负相关(r=-0.162,P=0.027;r=-0.165,P=0.024)。早产儿生后PEDF/VEGF比值恒定,且随日龄的增长而升高(r=0.237,P=0.000)。ROP组血清VEGF(P=0.000)水平在生后21d均较ROP对照组低,且随日龄的增长反有上升;PEDF水平随着日龄的增长未能体现上升趋势;PEDF/VEGF比值在生后第7天显著升高(P=0.036),生后35d内随着日龄的增长反有下降(r=-0.449,P=0.047)。结论发生ROP的早产儿血清VEObjective To observe the changes of serum VEGF and PEDF levels in premature infants, and to discuss the roles of VEGF and PEDF in pathogenesis of ROP and the predicting values for the development of ROP. Methods Preterm infants admitted into Children ＇s Hospital, Fudan University from Jun. 2006 to Jan. 2007 were chosen according to the inclusion and exclusion criterion. Those whose birth weight（BW） ≤2 000 g or gestational age（GA） ≤34 weeks joined in ROP-screen, and those who were diagnosed as ROP according to ICROP were included into ROP group. Those who didnt develop ROP were divided into 〈 32 weeks group, -33 ＋6weeks group, -36 ＋6weeks group. Serum collections were done at postnatal day（d）7, d14, d21, d28 and d.35. VEGF and PEDF levels were detected by ELISA. All data were analyzed by SPSS 13.0, with Linear Mixed Models-Repeated, Correlations, T-Test and Univariate Analysis of Variance. Results 170 preterm infants were included according to the inclusion and exclusion criterion, 6 of them were out of study for giving up therapy by parents, 11 of them developed ROP, those all were stage Ⅰ - Ⅲ ROP. In the remained 153 non-ROP infants, the number of GA 〈 32 weeks was 54, - 33 ＋6weeks was 48, - 36 ＋6 weeks was 51. In those preterm infants, serum VEGF levels decreased with advancing postnatal age（ r = - 0. 167, P = 0. 000）, and maintained stable after d21 （compared with d7： d14, P =0. 010; d21, P = 0. 000）. serum PEDF levels of preterm infants didnt change within the first 2 postnatal weeks （ P= 0.713）, but after the first 2 postnatal weeks, they increased with advancing postnatal age（ r = 0. 287, P=0.000） （compared withd7： d21, P=0.008; d28, P=0.001; d35, P=0.000）. GA＇s influence on VEGF and PEDF levels was more significant than BW. The smaller the GA, the higher would be the VEGF and PEDF levels. With the synergistic action of BW, the serum VEGF and PEDF levels in preterm infants were negatively correlated with GA （r = -0. 162, P =0. 027; r = -0. 165, P

关 键 词：早产儿视网膜病 血管内皮生长因子 色素上皮衍生因子 

分 类 号：R722.6[医药卫生—儿科] R774.1[医药卫生—临床医学]