宫内感染早产儿血清及脑脊液炎性因子与脑损伤的关系  

Relationship between cytokine levels in serum and cerebrospinal fluid and brain injury in preterm infant with ;intrauterine infection

作　　者：夏世文[1] 周茜茜[1] 胡玉莲[1] 祝华平[1] 李宁[1] 韩代成[1] 付春花[1] 张漪[1] 王慧[1] 刘红艳[1] 余晶[1] 陈样[1] 张佩[1] 

机构地区：[1]湖北省妇幼保健院新生儿科,武汉430070

出　　处：《中华实用儿科临床杂志》2015年第18期1425-1427,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：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。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 occurre

关 键 词：宫内感染 绒毛膜羊膜炎 炎性因子 脑损伤 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]