摘要
目的探讨不同胎龄及出生体质量早产儿血清Clara细胞分泌蛋白(CCSP)、高迁移率族蛋白B1(HMGB1)的表达,并分析其与早产儿胎龄、体质量及肺功能的相关性。方法选取2018年1月至2019年8月于南京医科大学附属常州妇幼保健院出生的117例早产儿作为研究对象,根据胎龄分为<32周组(35例)、32~<34周组(37例)及34~<37周组(45例),根据出生时体质量分为<1500 g组(31例)、1500~<2500 g组(52例)及≥2500 g组(34例)。检测并比较不同胎龄及出生体质量早产儿血清CCSP、HMGB1水平及肺功能指标[第一秒用力呼气量占用力肺活量百分比(FEV_(1)/FVC)、呼气峰流速(PEF)]。随访12个月,根据早产儿是否发生肺功能发育不良分为肺功能发育不良组和无肺功能发育不良组,采用Logistic回归分析影响早产儿发生肺功能发育不良的危险因素。采用Pearson相关分析血清CCSP、HMGB1与早产儿胎龄、体质量、肺功能的相关性。结果不同胎龄组早产儿血清CCSP、HMGB1及肺功能指标比较差异有统计学意义(P<0.01),随着早产儿胎龄增大,血清CCSP、FEV_(1)/FVC及PEF逐渐升高(P<0.05),HMGB1水平逐渐降低(P<0.05)。不同体质量组早产儿血清CCSP、HMGB1及肺功能指标比较差异有统计学意义(P<0.01),随着早产儿体质量的增加,血清CCSP、FEV_(1)/FVC及PEF逐渐上升(P<0.05),HMGB1水平逐渐下降(P<0.05)。多因素Logistic回归分析结果显示,胎龄、出生体质量、血清CCSP及HMGB1是早产儿发生肺功能发育不良的高危因素(OR=2.217,95%CI 1.168~3.265;OR=1.998,95%CI 1.126~2.869;OR=2.085,95%CI 1.047~3.124;OR=1.988,95%CI 1.096~2.879)(P<0.01)。Pearson相关分析结果显示,血清CCSP与胎龄、体质量、FEV_(1)/FVC、PEF呈正相关(r=0.433,P<0.001;r=0.420,P=0.035;r=0.577,P<0.001;r=0.736,P<0.001);血清HMGB1与胎龄、体质量、FEV_(1)/FVC、PEF呈负相关(r=-0.429,P<0.001;r=-0.419,P=0.016;r=-0.495,P<0.001;r=-0.550,P<0.001)。结论血清CCSP水平随着早产儿胎龄及出生体质量的增加而升高,HMGB1水平则随着早产儿胎龄及出生体质量的增加而下降,血清CCSP、HMGB1水平是影响早产儿肺功能发育不良的危险因素,且与肺功能存在一定相关性。
Objective To explore the expression of serum Clara cell secretory protein(CCSP)and high mobility group box 1 protein(HMGB1)in preterm infants with different gestational ages and birth weights,and analyze their correlation with gestational age,weight and lung function of preterm infants.Methods A total of 117 premature infants born in Changzhou Maternal and Child Health Hospital,Nanjing Medical University from Jan.2018 to Aug.2019 were included.According to the gestational age,they were divided into a<32 weeks group(35 cases),a 32-<34 weeks group(37 cases)and a 34-<37 weeks group(45 cases).According to birth weight,they were divided into a<1500 g group(31 cases),a 1500-<2500 g group(52 cases)and a≥2500 g group(34 cases).The serum CCSP,HMGB1 levels and lung function indexes of the preterm infants with different gestational ages and birth weights[forced expiratory volume in first second as a percentage of vital capacity(FEV_(1)/FVC)and peak expiratory flow rate(PEF)]were detected and compared.Follow-up was done for 12 months.According to the follow-up results,the preterm infants were divided into a pulmonary dysplasia group and a non-pulmonary dysplasia group.Logistic regression analysis was used to analyze the risk factors of premature pulmonary dysplasia.Pearson correlation was used to analyze the correlation of serum CCSP,HMGB1 with gestational age,weight and lung function of premature infants.Results There were statistically significant differences in serum CCSP,HMGB1 and pulmonary function indexes of preterm infants in different gestational age groups(P<0.01).With the increase of the gestational age,the level of CCSP,FEV_(1)/FVC and PEF increased gradually(P<0.05),while the HMGB1 level decreased gradually(P<0.05).There were statistically significant differences in serum CCSP,HMGB1 and pulmonary function indexes of preterm infants with different body weights(P<0.01).With the increase of the infant body weight,the serum CCSP,FEV_(1)/FVC gradually increased,while the HMGB1 gradually decreased(P<0.05).Multivariate Logistic regression analysis showed that gestational age,birth weight,serum CCSP and HMGB1 were all high-risk factors leading to pulmonary dysplasia in premature infants(OR=2.217,95%CI 1.168-3.265;OR=1.998,95%CI 1.126-2.869;OR=2.085,95%CI 1.047-3.124;OR=1.988,95%CI 1.096-2.879)(P<0.01).Pearson correlation analysis showed that serum CCSP was positively correlated with gestational age,body weight,FEV_(1)/FVC and PEF(r=0.433,P<0.001;r=0.420,P=0.035;r=0.577,P<0.001;r=0.736,P<0.001).Serum HMGB1 was negatively correlated with gestational age,body weight,FEV_(1)/FVC and PEF(r=-0.429,P<0.001;r=-0.419,P=0.016;r=-0.495,P<0.001;r=-0.550,P<0.001).Conclusion The level of serum CCSP increases,and the level of HMGB1 decreases with the increase of gestational age and birth weight of preterm infants.Serum CCSP and HMGB1 levels are risk factors for pulmonary dysplasia of premature infants,and have a certain correlation with pulmonary function.
作者
刘滢
朱荣平
张琳
LIU Ying;ZHU Rongping;ZHANG Lin(Department of Neonatology,Changzhou Maternal and Child Health Hospital,Nanjing Medical University,Changzhou 213000,China)
出处
《医学综述》
CAS
2022年第21期4359-4364,共6页
Medical Recapitulate
