血清氨基末端脑钠肽前体及白细胞介素-6水平在新生儿呼吸窘迫综合征早期诊断和严重程度评估中的应用
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摘要
目的评估血清氨基末端脑钠肽前体(NT-proBNP)及白细胞介素(IL)-6水平在新生儿呼吸窘迫综合征(RDS)诊断和严重程度评估中的应用价值。方法以2016年8月至2018年3月在南方医科大学附属中山博爱医院新生儿科住院治疗的150例RDS早产儿为研究对象(研究组),根据胸片成像再分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级;以同期住院的158例早产儿为对照(对照组)。分别于生后第1、3、7天检测血清NT-proBNP及IL-6水平,同时监测他们的肺动脉压(PAP)。结果研究组生后第1 (t=-91. 04,P=0. 000; t=-11. 03,P=0. 000)、3 (t=-89. 10,P=0. 000; t=-9. 909,P=0. 000)及7天(t=-87. 91,P=0. 000; t=-8. 548,P=0. 000)的NT-proBNP和IL-6水平均明显高于对照组。各级RDS患儿生后第1 (F=50. 89,P=0. 000)、3 (F=49. 16,P=0. 000)、7天(F=45. 45,P=0. 000)的NT-proBNP水平差异有统计学意义,并呈逐级升高的趋势。各级RDS患儿生后第1 (F=0. 89,P=0. 448)、3 (F=0. 76,P=0. 518)、7天(F=0. 85,P=0. 469)的IL-6水平差异无统计学意义。研究组患儿生后第1、3、7天的PAP分别为(49. 3±3. 7)、(40. 1±5. 4)、(39. 0±2. 6) mm Hg (1 mm Hg=0. 133 k Pa),均明显高于对照组的(35. 0±2. 7)(t=-90. 01,P=0. 000)、(30. 0±3. 1)(t=-81. 90,P=0. 000)、(26. 0±3. 0) mm Hg (t=-88. 89,P=0. 000)。相关性分析结果显示,NT-proBNP与IL-6 (r=0. 876,P=0. 000)和PAP (r=0. 916,P=0. 000)均呈显著正相关。结论监测血清NT-proBNP水平有助于RDS早产儿的早期诊断及严重程度评估。
Objective To evaluate the value of serum aminoterminal pro-brain natriuretic peptide( NTpro BNP) and interleukin( IL)-6 levels in diagnosis and severity assessment of the preterm infants with respiratory distress syndrome( RDS). Methods Totally 150 preterm infants with RDS who were hospitalized in our center from August 2016 to March 2018 were enrolled in this study as the RDS group. These infants were further divided into grades Ⅰ,Ⅱ,Ⅲ,and Ⅳ according to chest radiography. In addition,158 preterm infants without RDS hospitalized in our center during the same period were included as the controls( control group). Serum NTpro BNP and IL-6 levels were measured by ELISA on days 1,3,and 7 after birth,and their pulmonary arterial pressure( PAP) was monitored as well. Results Serum NT-proBNP and IL-6 levels in RDS group were significantly higher than those in control group on day 1( t =-91. 04,P = 0. 000; t =-11. 03,P = 0. 000),day 3( t =-89. 10,P =0. 000; t =-9. 909,P = 0. 000),and day 7( t =-87. 91,P = 0. 000; t =-8. 548,P =0. 000). There were significant differences in NT-proBNP levels among gradesⅠ,Ⅱ,Ⅲ,and Ⅳ on day 1( F =50. 89,P = 0. 000),day 3( F = 49. 16,P = 0. 000),and day 7( F = 45. 45,P = 0. 000),showing an increasing trend. Serum IL-6 levels showed no significant difference among gradesⅠ,Ⅱ,Ⅲ,and Ⅳ on day 1( F = 0. 89,P = 0. 448),day 3( F = 0. 76,P = 0. 518),and day 7( F = 0. 85,P = 0. 469). The PAP of the RDS group on days 1,3,and 7 was( 49. 3 ± 3. 7),( 40. 1 ± 5. 4),and( 39. 0 ± 2. 6) mm Hg( 1 mm Hg = 0. 133 k Pa),which were significantly higher than those of the control group( 35. 0 ± 2. 7) mm Hg( t =-90. 01,P = 0. 000),( 30. 0 ±3. 1) mm Hg( t =-81. 90,P = 0. 000),( 26. 0 ± 3. 0) mm Hg( t =-88. 89,P = 0. 000). Thus,there was a positive correlation between NT-proBNP and IL-6 levels( r = 0. 876,P = 0. 000) and a positive correlation between NT-proBNP and PAP( r = 0. 916,P = 0. 000) in preterm infants with RDS. Conclusion Monitoring serum NT-proBN contributes to early diagnosis and disease severity assessment in preterm infants with RDS.
Objective To evaluate the value of serum aminoterminal pro-brain natriuretic peptide( NTpro BNP) and interleukin( IL)-6 levels in diagnosis and severity assessment of the preterm infants with respiratory distress syndrome( RDS). Methods Totally 150 preterm infants with RDS who were hospitalized in our center from August 2016 to March 2018 were enrolled in this study as the RDS group. These infants were further divided into grades Ⅰ,Ⅱ,Ⅲ,and Ⅳ according to chest radiography. In addition,158 preterm infants without RDS hospitalized in our center during the same period were included as the controls( control group). Serum NTpro BNP and IL-6 levels were measured by ELISA on days 1,3,and 7 after birth,and their pulmonary arterial pressure( PAP) was monitored as well. Results Serum NT-proBNP and IL-6 levels in RDS group were significantly higher than those in control group on day 1( t =-91. 04,P = 0. 000; t =-11. 03,P = 0. 000),day 3( t =-89. 10,P =0. 000; t =-9. 909,P = 0. 000),and day 7( t =-87. 91,P = 0. 000; t =-8. 548,P =0. 000). There were significant differences in NT-proBNP levels among gradesⅠ,Ⅱ,Ⅲ,and Ⅳ on day 1( F =50. 89,P = 0. 000),day 3( F = 49. 16,P = 0. 000),and day 7( F = 45. 45,P = 0. 000),showing an increasing trend. Serum IL-6 levels showed no significant difference among gradesⅠ,Ⅱ,Ⅲ,and Ⅳ on day 1( F = 0. 89,P = 0. 448),day 3( F = 0. 76,P = 0. 518),and day 7( F = 0. 85,P = 0. 469). The PAP of the RDS group on days 1,3,and 7 was( 49. 3 ± 3. 7),( 40. 1 ± 5. 4),and( 39. 0 ± 2. 6) mm Hg( 1 mm Hg = 0. 133 k Pa),which were significantly higher than those of the control group( 35. 0 ± 2. 7) mm Hg( t =-90. 01,P = 0. 000),( 30. 0 ±3. 1) mm Hg( t =-81. 90,P = 0. 000),( 26. 0 ± 3. 0) mm Hg( t =-88. 89,P = 0. 000). Thus,there was a positive correlation between NT-proBNP and IL-6 levels( r = 0. 876,P = 0. 000) and a positive correlation between NT-proBNP and PAP( r = 0. 916,P = 0. 000) in preterm infants with RDS. Conclusion Monitoring serum NT-proBN contributes to early diagnosis and disease severity assessment in preterm infants with RDS.
引文
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[12] Ozalkaya E,Karatekin G,Topcuoˇglu S,et al. Morbidity inpreterm infants with fetal inflammatory response syndrome[J].Pediatr Int,2016,58(9):850-854. DOI:10. 111/ped. 12895.
[13] Hassanein SM, El-Farrash RA, Hafez HM, et al. Cordblood interleukin-6 and neonatal morbidities among preterminfants with PCR-positive Ureaplasma urealyticum[J]. MaternFetal Neonatal Med, 2012, 25(10):2106-2110. DOI:10. 3109/14767058. 2012. 678435.
[2] Delorme P,Goffinet F,Ancel PY,et al. Cause of pretermbirth as a prognostic factor for mortality[J]. Obstet Gynecol,2016,127(1):40-48. DOI:10. 1097/AOG. 0000000000001179.
[3] Baker CD,Abman SH,Mourani PM. Pulmonary hyperten-sion in preterm infants with bronchopulmonary dysplasia[J].Pediatr Allergy Immunol Pulmonol,2014,27(1):8-16.DOI:10. 1089/ped. 2013. 0323.
[4] El Hajjar M,Vaksmann G,Rakza T,et al. Severity of theductal shunt:a comparison of different markers[J]. Arch DisChild Fetal Neonatal Ed,2005,90(5):F419-F422. DOI:10. 1136/adc. 2003. 027698.
[5] Rocha G,Clemente F,Rodrigues T,et al. Clinical signifi-cance of plasma N-terminal pro-B-type natriuretic peptide inrespiratory distress syndrome of the preterm neonate[J]. ActaMed Port,2009,22(2):349-354.
[6] Pesonen E,Heldt GP,Merritt TA,et al. Atrial natriureticfactor andpulmonary status in premature infants with respiratorydistress syndrome:preliminary investigation[J]. PediatrPulm Onol,1993,15(6):362-364.
[7] Khoshdel A,Kheiri S,Omidvari P,et al. Association be-tween iterleukin-10-1082 G/A and tumor necrosis factor-α308 G/A gene polymorphisms and respiratory distress syn-drome in Iranian preterm infants[J]. Mediators Inflamm,2017:6386453. DOI:10. 1155/2017/6386453.
[8] Varvarigou AA,Thomas I,Rodi M,et al. Respiratory dis-tress syndrome(RDS)in premature infants is underscored bythe magnitude of Th1 cytokine polarization[J]. Cytokine,2012,58(3):355-360. DOI:10. 1016/j. cyto. 2012. 03. 005.
[9]邵肖梅,叶鸿瑁,邱小汕.实用新生儿学[M].第4版.北京:人民卫生出版社,2011:396.
[10] Pilypiene I,Drazdiene N,Dumalakiene I,et al. The signif-icance of fetal inflammatory response syndrome in early andlater adaptation of premature infants[J]. Arch Gynecol Ob-stet,2015,291(1):67-72. DOI:10. 1007/s00404-014-3386-2.
[11]杜立中.新生儿呼吸系统疾病的诊断进展与争议[M].北京:人民卫生出版社,2010:138-142.
[12] Ozalkaya E,Karatekin G,Topcuoˇglu S,et al. Morbidity inpreterm infants with fetal inflammatory response syndrome[J].Pediatr Int,2016,58(9):850-854. DOI:10. 111/ped. 12895.
[13] Hassanein SM, El-Farrash RA, Hafez HM, et al. Cordblood interleukin-6 and neonatal morbidities among preterminfants with PCR-positive Ureaplasma urealyticum[J]. MaternFetal Neonatal Med, 2012, 25(10):2106-2110. DOI:10. 3109/14767058. 2012. 678435.