脐血白细胞介素-6对早产儿脑损伤预后判断的价值

Significance of cord interleukin-6 in the evaluation of the prognosis of preterm neonatal brain damage

摘要:

目的：探讨母亲的绒毛膜羊膜炎、脐血IL-6水平与早产儿脑损伤以及出生后3年间的神经系统后遗症之间的相互关系，了解临床检测脐血IL-6水平的意义，为及时诊断早产儿脑损伤、早期预防神经系统发育性障碍提供理论依据。方法：研究对象为26例早产儿。用ELISA方法检测早产儿脐血中IL-6水平；将母亲的胎膜组织行病理学检查，以诊断有无绒毛膜羊膜炎；早产儿生后3 d内行头颅超声或CT检查，以协助诊断有无脑损伤；随访早产儿出生后3年间的神经系统后遗症情况。结果：①有脑损伤的早产儿脑瘫、癫痫等神经系统发育性障碍的发生高于无脑损伤组；②母亲有绒毛膜羊膜炎组神经系统发育性障碍者增高；③有神经系统发育性障碍的早产儿的脐血IL-6水平明显高于无脑损伤组。结论：母亲的绒毛膜羊膜炎与早产儿脑损伤及其后发生的神经系统后遗症密切相关，故预防和积极治疗母亲的宫内感染对预防早产儿脑损伤以及降低脑瘫等严重神经系统后遗症的发病率均具有重要意义。脐血中的IL-6水平升高可能在母亲宫内感染导致早产儿发生脑损伤的过程中起重要的介导作用。

Abstract:

OBJECTIVE: To explore the relationship among maternal choriamnionitis, cord interleukin-6 (IL-6) concentration, brain damage and neurological deficits in the first 3 years of life, and to study the significance of cord IL-6 in the evaluation of the prognosis of preterm neonatal brain damage. METHODS: Twenty-six preterm neonates born between May, 1998 and February, 1999 were enrolled in this study. The cord IL-6 concentration was detected by ELISA. Maternal choriamnionitis was confirmed by histological examination of the placenta. All infants had either ultrasonography or CT in the first three days of their lives and a subsequent follow-up visit within three years of their lives. RESULTS: The incidence of neurological deficits was higher in preterm infants with brain damage than that in those without. The incidence of neurological deficits was also higher in those whose mothers had choriamnionitis. The cord IL-6 concentration in preterm infants with neurological deficits was higher than that in those without. CONCLUSIONS: Maternal chorioamnionitis may result in an increased incidence of brain damage and subsequent development of neurological deficits in preterm infants. It is therefore very important to prevent and treat maternal intrauterine infections early with the view to decreasing the risk of subsequent neurologic deficits. Cord IL-6 may be elevated in maternal chorioamnionitis and may predict the subsequent development of neurological deficits.