摘要
目的对比血清白细胞介素6-(IL-6)水平在母亲非感染性合并症早产儿及宫内感染的早产儿间的差异,探讨IL-6在早产儿宫内感染诊断中的意义。方法选取2019年1-12月于雅安市人民医院产科分娩,胎龄28~36周、单胎活胎、转入该院新生儿科的早产儿,将其胎膜胎盘送病理检查,同时行血清(产前母血、出生即刻脐血及出生后24 h内新生儿静脉血)IL-6水平检测。将符合宫内感染诊断标准而母亲无其他合并症的早产儿纳入宫内感染组,母亲有非感染性合并症而无感染证据的早产儿纳入非感染合并症组,无感染证据且母亲无合并症的早产儿纳入对照组,其中宫内感染组46例,非感染合并症组43例,对照组40例,比较各组血清IL-6水平。结果宫内感染组母血、脐血、新生儿血IL-6水平高于非感染合并症组及对照组,差异有统计学意义(P<0.05);非感染合并症组和对照组仅母血IL-6水平差异有统计学意义(Z=-6.552,P<0.001),脐血(Z=-0.028,P=0.978)和新生儿血IL-6水平(Z=-0.450,P=0.653)差异无统计学意义;母血、脐血、新生儿血IL-6水平预测早产儿宫内感染的ROC曲线下面积分别是0.877、0.881、0.924;母血、脐血、新生儿血IL-6水平的最佳截断值分别为14.950、3.250、4.250 pg/mL,3项指标中新生儿血IL-6水平预测早产儿宫内感染敏感度和特异度均最高,分别为89.1%、96.4%;母血IL-6水平预测母亲非感染性合并症的ROC曲线下面积是0.907,母血IL-6水平的截断值取5.50 pg/mL时,其敏感度和特异度分别为93.0%、87.5%。结论早产儿宫内感染时母血、脐血及新生儿血IL-6水平均明显升高,而母亲非感染合并症时仅母血IL-6水平升高,其中新生儿血IL-6水平在早产儿宫内感染时最敏感,且有助于宫内感染与母亲非感染合并症的鉴别,故新生儿出生时血清IL-6水平对于早产儿宫内感染诊断具有重要意义。
Objective To compare the differences of the serum interleukin 6(IL-6)levels between the preterm infants with non-infectious maternal comorbidities and those with intrauterine infection and explore the significance of IL-6 in diagnosing the intrauterine infection of preterm infants.Methods The preterm infants with the gestational age of 28-36 weeks who were delivered single and alive in Ya'an People's Hospital from January to December of 2019 were selected,and their fetal membrane and placenta were sent for pathological examination.Meanwhile,the serum IL-6 levels in the maternal blood,umbilical cord blood at birth and neonatal venous blood within 24 hours after birth were analyzed.Those with intrauterine infection and no maternal comorbidities were included in the intrauterine infection group(n=46),those with non-infectious maternal comorbidities and no evidences of intrauterine infection were included in the non-infectious comorbidity group(n=43),and those with no maternal comorbidities and evidences of intrauterine infection were included in the control group(n=40).The levels of IL-6 in each group were compared.Results The levels of IL-6 in the maternal,umbilical cord and neonatal blood were significantly higher in the intrauterine infection group than in the non-infectious comorbidity group and the control group,and the differences were statistically significant(P<0.05).There was statistically significant difference in the IL-6 levels of maternal blood(Z=-6.552,P<0.001)and no statistically significant differences in those of umbilical cord blood(Z=-0.028,P=0.978)and neonatal blood(Z=-0.450,P=0.653)between the non-infectious comorbidity group and the control group.The areas under the ROC curve for predicting the intrauterine infection of preterm infants with the IL-6 levels of the maternal,umbilical cord and neonatal blood were 0.877,0.881 and 0.924 respectively,and the optimal cutoff values were 14.950 pg/mL,3.250 pg/mL and 4.250 pg/mL respectively.Among all the three indices,the sensitivity and specificity of predicting intrauterine infection of preterm infants with the IL-6 levels of neonatal blood were the highest and they were 89.1%and 96.4%.The area under the ROC curve for predicting non-infectious maternal comorbidities with the IL-6 levels of maternal blood was 0.907.And when the cut-off value of the IL-6 level of maternal blood was 5.50 pg/mL,the sensitivity,specificity were 93.0%and 87.5%respectively.Conclusion The IL-6 levels of the maternal,umbilical cord and neonatal blood increase significantly in preterm infants with intrauterine infection,while those of maternal blood rise in those with non-infectious maternal comorbidities.The IL-6 levels of neonatal blood are the most sensitive for intrauterine infection,which is helpful to distinguish intrauterine infection from non-infectious maternal comorbidities.Therefore,the serum IL-6 levels at birth are of great significance in diagnosing the intrauterine infection of preterm infants.
作者
陈伟
邹永蓉
鲁利群
周扬
Chen Wei;Zou Yongrong;Lu Liqun;Zhou Yang(Department of Neonatology, Ya'an People's Hospital, Ya'an 625000, China;Department of Pediatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China;Department of Obstetrics and Gynecology, Ya'an People's Hospital, Ya'an 625000, China)
出处
《成都医学院学报》
CAS
2020年第4期478-481,485,共5页
Journal of Chengdu Medical College
基金
四川省雅安市科学技术和知识产权局科研项目(No:2018yyjskf10)。
关键词
白细胞介素6
早产儿
宫内感染
非感染性合并症
Interleukin-6
Preterm infants
Intrauterine infection
Non-infectious comorbidity
