新生儿GBS感染所致化脓性脑膜炎中血清维生素D和炎性细胞因子的表达及意义  

Expression and significance of serum vitamin D and inflammatory cytokines in neonatal purulent meningitis caused by GBS infection

作　　者：乔木[1] 韩雁雁 姚文秀[1] Qiao Mu;Han Yanyan;Yao Wenxiu(Department of Neonatology,the First Hospital of Qinhuangdao,Hebei,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院新生儿科,河北秦皇岛066000

出　　处：《发育医学电子杂志》2024年第2期96-101,共6页Journal of Developmental Medicine (Electronic Version)

基　　金：秦皇岛市科学技术研究与发展计划(202004A065)。

摘　　要：目的检测新生儿B族链球菌(group B streptococcus,GBS)感染所致化脓性脑膜炎(purulent meningitis,PM)血清中维生素D、白细胞介素(interleukin,IL)-6、IL-10、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和C反应蛋白(c-reactive protein,CRP)的表达水平,并探讨其临床价值。方法选取2017年5月至2020年5月在秦皇岛市第一医院出生的59例GBS感染的PM新生儿纳入观察组,同期59例非GBS感染的PM新生儿(晚发败血症)纳入对照组。检测所有受试者血清维生素D、CRP、IL-6、IL-10和TNF-α水平,并进行Pearson相关性分析;利用受试者操作特征(receiver operating characteristic,ROC)曲线分析血清维生素D和炎性细胞因子对新生儿GBS感染所致PM的诊断价值。统计学方法采用t检验、χ^(2)检验和Pearson相关性分析。结果观察组与对照组孕产妇胎膜早破[47.5%(28/59)与5.1%(3/59),χ^(2)=27.345]、产时窒息[52.5%(31/59)与18.6%(11/59),χ^(2)=14.787]和产褥感染[(44.1%(26/59)与(22.0%(13/59)),χ^(2)=6.473]的发生率比较,观察组明显高于对照组(P<0.05)。观察组血清维生素D水平显著低于对照组[(13.3±2.1)μg/L与(21.1±5.0)μg/L,t=11.345],IL-6[(87.1±14.5)μg/L与(63.9±11.9)μg/L,t=9.507]、IL-10[(49.6±15.2)μg/L与(29.3±10.0)μg/L,t=8.596]、TNF-α[(76.8±19.0)μg/L与(50.0±10.8)μg/L,t=9.410]和CRP[(21.5±5.0)μg/L与(13.7±3.7)μg/L,t=9.702]水平显著高于对照组(P值均<0.05)。Pearson相关性分析结果显示,观察组血清维生素D水平分别与IL-6、IL-10、TNF-α和CRP水平呈负相关(r=-0.662、-0.644、-0.564、-0.643,P<0.05);血清维生素D、IL-6、IL-10、TNF-α和CRP单独诊断GBS感染新生儿PM的曲线下面积(area under the curve,AUC)分别为0.831(95%CI:0.757~0.904)、0.887(95%CI:0.830~0.944)、0.859(95%CI:0.793~0.925)、0.888(95%CI:0.821~0.955)、0.879(95%CI:0.820~0.938),5项联合检测的AUC为0.991(95%CI:0.978~1.000)。结论GBS感染所致的PM新生儿血清中维生素D水平降低,炎性细胞因子水平增加,Objective To detect the expression levels of interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor(TNF-α)and C-reactive protein(CRP)in purulent meningitis(PM)caused by group B streptococcus(GBS)infection in neonates,and to discuss their clinical value.Method 59 PM newborns with GBS infection born in the First Hospital of Qinhuangdao from May 2017 to May 2020 were DOI:10.3969/included in the observation group,and 59 PM newborns without GBS infection(late-onset sepsis)were included in the control group during the same period.The levels of serum vitamin D,CRP,IL-6,IL-10 and TNF-αwere detected in all subjects,and Pearson correlation analysis was performed.The diagnostic value of serum vitamin D and inflammatory cytokines in PM neonates with GBS infection was analyzed by receiver operating characteristic(ROC)curve.The statistical methods performed by t-test,χ^(2) test and Pearson correlation analysis.Result The pregnant women in the observation group had premature rupture of fetal membrane[47.5%(28/59)and 5.1%(3/59),χ^(2)=27.345],asphyxia during labor[52.5%(31/59)vs 18.6%(11/59)]and[(44.1%(26/59)vs 22.0%(13/59),χ^(2)=6.473]was significantly higher than that of the control group(P<0.05).Serum vitamin D level in the observation group was significantly lower than that in control group[(13.3±2.1)μg/L vs(21.1±5.0)μg/L,t=11.345].The observation group were significantly higher than those in control group in IL-6[(87.1±14.5)μg/Land(63.9±11.9)μg/L,t=9.507],IL-10[(49.6±15.2)μg/L and(29.3±10.0)μg/L,t=8.596],the TNF-α[(76.8±19.0)μg/L vs(50.0±10.8)μg/L,t=9.410]and CRP[(21.5±5.0)μg/L vs(13.7±3.7)μg/L,t=9.702](P<0.05).The Pearson correlation analysis results showed that the serum vitamin D level in the observation group was negatively correlated with the levels of IL-6,IL-10,TNF-αand CRP,respectively(r=-0.662,-0.644,-0.564,-0.643,P<0.05).The area under the curve(AUC)of serum vitamin D,IL-6,IL-10,TNF-αand CRP in the alone diagnosis of neonatal PM with GBS infection were 0.831(95%CI:0.757-0.904),0

关 键 词：B族链球菌 新生儿化脓性脑膜炎 维生素D 白细胞介素-6 白细胞介素-10 肿瘤坏死因子-α C反应蛋白 

分 类 号：R722.1[医药卫生—儿科]