新生儿呼吸窘迫综合征无创经皮血气+体位管理+保护性通气前后MMP-16、Claudin-18、CC16变化及与并发支气管肺发育不良的相关性  

Changes in MMP-16,Claudin-18 and CC16 before and after non-invasive transcutaneous blood gas+postural management+protective ventilation in neonatal respiratory distress syndrome and their correlation with concurrent BPD

作　　者：田金凤 杨华蕾[1] 王小雷 聂军红 TIAN Jin-feng;YANG Hua-lei;WANG Xiao-lei;NIE Jun-hong(Department of Pediatrics,the Second People′s Hospital of Hengshui City,Hebei Province,Hengshui 053000,China)

机构地区：[1]河北省衡水市第二人民医院儿科,河北衡水053000

出　　处：《河北医科大学学报》2024年第5期524-529,共6页Journal of Hebei Medical University

基　　金：衡水市科技计划项目(2022014086Z)。

摘　　要：目的探讨无创经皮血气+体位管理+保护性通气干预新生儿呼吸窘迫综合征对患儿基质金属蛋白酶16(matrix metalloproteinase 16,MMP-16)、紧密连接蛋白18(Claudin 18 protein,Claudin-18)和Clara细胞分泌蛋白16(Clara cell secretes protein 16,CC16)的影响,并分析上述指标与支气管肺发育不良(bronchopulmonary dysplasia,BPD)的相关性。方法前瞻性选取呼吸窘迫综合征新生儿106例为研究对象,所有患儿均接受无创经皮血气+体位管理+保护性通气干预,观察患儿干预前后MMP-16、Claudin-18、CC16变化。统计患儿2周内BPD发生状况,并将其分为BPD组与非BPD组,分析MMP-16、Claudin-18、CC16与BPD发生的关系。结果干预后,MMP-16水平低于干预前,Claudin-18、CC16水平高于干预前(P<0.05);106例呼吸窘迫综合征患儿中发生BPD 57例,占53.77%;与非BPD组相比,BPD组MMP-16水平更高,Claudin-18、CC16水平更低(P<0.05);经点二列相关性分析,结果显示,MMP-16与BPD发生呈正相关(r=0.542,P<0.05),Claudin-18、CC16水平与BPD发生呈负相关(r=-0.526,-0.639,P<0.05);经Logistic回归分析,结果显示,MMP-16是呼吸窘迫综合征患儿并发BPD的危险因素(OR>1,P<0.05),Claudin-18、CC16是保护因素(OR<1,P<0.05);绘制受试者工作曲线(receiver operating characteristic curve,ROC)曲线,结果显示,MMP-16、Claudin-18、CC16评估呼吸窘迫综合征患儿并发BPD的AUC均>0.7,具有一定评估价值,联合评估价值更高(AUC=0.902)。结论无创经皮血气+体位管理+保护性通气可改善降低急性呼吸窘迫综合征患儿MMP-16水平,升高Claudin-18、CC16水平,上述3项指标变化与BPD的发生密切相关。Objective To investigate the effects of noninvasive transcutaneous blood gas+postural management+protective ventilation intervention for neonatal respiratory distress syndrome(NRDS)on matrix metalloproteinase-16(MMP-16),Claudin-18,and Clara cell secretory protein 16(CC16)in children,and to analyze the correlation between the above indicators and bronchopulmonary dysplasia(BPD).Methods A total of 106 neonates with NRDS were selected prospectively for the study,and all children received noninvasive transcutaneous blood gas+postural management+protective ventilation intervention.The changes of MMP-16,Claudin-18,and CC16 in neonates were observed before and after intervention.The incidence of BPD in neonates was calculated within two weeks of intervention,and children were divided into BPD group and non-BPD group,to analyze the relationship between MMP-16,Claudin-18,CC16 and BPD.Results After intervention,MMP-16 levels were lower than those before intervention,while Claudin-18 and CC16 levels were higher than those before intervention(P<0.05).BPD occurred in 57 of 106 children with NRDS,accounting for 53.77%.Compared with the non-BPD group,MMP-16 levels were higher and Claudin-18 and CC16 levels were lower in the BPD group(P<0.05).By point-biserial correlation analysis,the results showed that MMP-16 was positively correlated with the occurrence of BPD(r=0.542,P<0.05),and Claudin-18 and CC16 levels were negatively correlated with the occurrence of BPD(r=-0.526,-0.639,P<0.05).By logistic regression analysis,the results showed that MMP-16 was a risk factor for the complication of BPD in children with NRDS(OR>1,P<0.05),and Claudin-18 and CC16 were protective factors(OR<1,P<0.05).Receiver operating characteristic(ROC)curve was drawn,which showed that the area under the ROC curve(AUC)of MMP-16,Claudin-18 and CC16 for the assessment of BPD in children with NRDS was all>0.7,showing assessment value.The value of the combined assessment was higher(AUC=0.902).Conclusion Noninvasive transcutaneous blood gas+postural management+p

关 键 词：呼吸窘迫综合征 新生儿 血气监测 经皮 体位 

分 类 号：R722.12[医药卫生—儿科]