中性粒细胞胞外诱捕网在新生儿败血症中的表达和临床意义  

The expression and clinical significance of neutrophil extracellular trapping nets in neonatal sepsis

作　　者：刘雪姮 俞生林[1] 高沙沙[1] 缪欣欣 管欣娴[1] 高楚楚 Liu Xueheng;Yu Shenglin;Gao Shasha;Miao Xinxin;Guan Xinxian;Gao Chuchu(Department of Neonatology,Children's Hospital of Soochow University,Soochow 215025,China;Department of Neonatology,Suzhou Municipal Hospital,Soochow 215000,China)

机构地区：[1]苏州大学附属儿童医院新生儿科,苏州215025 [2]苏州市立医院新生儿科,苏州215000

出　　处：《中华新生儿科杂志（中英文）》2022年第3期219-224,共6页Chinese Journal of Neonatology

基　　金：江苏省妇幼健康科研项目(F202021);苏州市科技局-基础应用研究项目(sys2018070);江苏省研究生科研与实践创新计划项目(KYCX20-2724)。

摘　　要：目的探讨中性粒细胞胞外诱捕网(neutrophil extracellular traps,NETs)在新生儿败血症中的表达及意义。方法采用前瞻性研究方法,选取2020年6~11月在苏州大学附属儿童医院新生儿科初次住院的败血症足月儿为败血症组,按约1∶1的比例选取同期收治、与败血症组患儿胎龄相差<1周、家长同意参加研究的轻度高胆红素血症足月儿为对照组。收集两组患儿临床资料,抽取患儿入院第1天血样,酶联免疫吸附法检测NETs标志物瓜氨酸组蛋白H3-DNA(citrulline histone H3-DNA,CitH3-DNA)、荧光酶标仪检测血浆游离DNA(circulating cell-free DNA,cfDNA)水平。比较两组患儿一般资料、白细胞、中性粒细胞计数、血小板、C-反应蛋白(C-reactive protein,CRP)、血培养结果、CitH3-DNA和cfDNA水平,采用受试者工作特征曲线分析CitH3-DNA和cfDNA对新生儿败血症的诊断价值。结果共纳入74例,其中败血症组39例,对照组35例。败血症组CitH3-DNA和cfDNA均高于对照组[CitH3-DNA(光密度值):0.85±0.05比0.48±0.03,cfDNA(mg/L):0.90±0.05比0.56±0.03],差异有统计学意义(P<0.01)。CitH3-DNA和cfDNA无明显相关性(P>0.05)。CitH3-DNA与性别、胎龄、日龄、出生体重、白细胞、中性粒细胞计数、血小板、CRP均无明显相关性(P>0.05);cfDNA与日龄、中性粒细胞计数成正相关(P<0.05),与血小板成负相关(P<0.05)。在联合诊断败血症方面,CitH3-DNA+CRP、cfDNA+CRP及CitH3-DNA+cfDNA+CRP的受试者工作特征曲线下面积分别为0.947、0.947和0.970,预测新生儿败血症的敏感度分别为92.3%、84.6%和94.9%,特异度分别为94.3%、97.1%和100%,均高于各项指标单独诊断的预测价值。结论新生儿败血症患儿外周血清NETs呈高表达,尤其是CitH3-DNA,可作为新生儿败血症早期诊断的标志物,与CRP联合检测可明显提高对新生儿败血症的预测价值。Objective To study the expression and significance of neutrophil extracellular traps(NETs)in neonatal sepsis.Methods Prospective research were used in this study.Term infants with neonatal sepsis hospitalized for the first time in the Department of Neonatology,Children's Hospital of Soochow University from June 2020 to November 2020 were selected as the sepsis group.According to a ratio of about 1∶1,term infants with mild hyperbilirubinemia who were admitted in the same period,with gestational age difference less than 1 week from those in the sepsis group,and whose parents agreed to participate in the study were selected as the control group.On admission,clinical data as well as blood samples of the two groups were collected.Levels of NETs marker citrulline histone H3-DNA(CitH3-DNA)were detected by Enzyme-linked immunosorbent assay,and circulating cell-free DNA(cfDNA)was tested by the fluorescence microplate reader.General data,white blood cell(WBC),neutrophil count(NE),platelet(PLT),C-reactive protein(CRP),blood culture,CitH3-DNA and cfDNA were compared between the two groups.The diagnostic value of CITH3-DNA and cfDNA in neonatal septicemia was analyzed by the receiver operating characteristic(ROC)curve.Results A total of 74 infants were included in the study,including 39 cases in the sepsis group and 35 cases in the control group.CitH3-DNA and cfDNA in the sepsis group were significantly higher than those in the control group[CitH3-DNA(optical density):0.85±0.05 vs.0.48±0.03,cfDNA(mg/L):0.90±0.05 vs.0.56±0.03](P<0.01).There was no significant correlation between CitH3-DNA and cfDNA.The level of CitH3-DNA had no correlation with gender,gestational age,age,birth weight,WBC,NE,PLT and CRP(P>0.05).cfDNA was positively correlated with age and NE(P<0.05),and negatively correlated with PLT(P<0.05).Combined with CRP,the area under the ROC curve of CitH3-DNA+CRP,cfDNA+CRP,and CitH3-DNA+cfDNA+CRP were 0.947,0.947 and 0.970 respectively,and the sensitivity to predict neonatal sepsis were 92.3%,84.6%and 94.9%respect

关 键 词：败血症 中性粒细胞胞外诱捕网 瓜氨酸组蛋白H3-DNA 血浆游离DNA 婴儿 新生 

分 类 号：R722.131[医药卫生—儿科]