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目的观察早产儿出生时外周血Toll样受体4(Toll-like receptor 4,TLR-4)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)的水平及校正胎龄6个月龄时智力发育测试(CDCC)结果,探讨其在早产发生机制中的作用及其与早产儿脑损伤预后的关系,为预防早产及对脑损伤早期干预提供依据。方法新生儿120例,分为:足月儿40例、胎膜早破早产儿40例和特发性早产儿40例。采用ELISA检测新生儿外周静脉血中TLR-4、TNF-α的水平,校正胎龄达6个月时做婴幼儿CDCC。结果两组早产儿血清TLR-4、TNF-α水平均高于足月新生儿组,差异有统计学意义(P<0.05);两组早产儿血清TLR-4、TNF-α均呈正相关,差异有统计学意义(P<0.01)。随访CDCC异常者出生时外周血清中TLR-4、TNF-α水平明显高于正常者水平,二者比较差异有统计学意义(P<0.01)。结论早产儿血清TLR-4、TNF-α水平均高于足月新生儿,提示细胞因子TLR-4、TNF-α的激活与胎膜早破早产、特发性早产分娩发动机制密切相关;TLR-4、TNF-α呈正相关性,提示TLR-4可能作为上游因子通过激活细胞因子TNF-α而发挥促进早产分娩的作用。早产儿出生时外周血中TLR-4、TNF-α水平可作为早期判断脑损伤预后的指标。
Objective To observe the levels of Toll-like receptor 4 (TLR-4) and tumor necrosis factor-α (TNF-α) in peripheral blood of premature infants and the corrected gestational age of 6 months old (CDCC) results to explore its role in the mechanism of premature birth and its relationship with the prognosis of brain injury in premature infants, to provide evidence for the prevention of premature delivery and early intervention of brain injury. Methods 120 cases of newborns were divided into: full-term children in 40 cases, 40 cases of premature rupture of membranes and 40 cases of idiopathic premature children. The levels of TLR-4 and TNF-α in peripheral blood of neonates were detected by ELISA, and CDCC was made in infants and young children at the corrected gestational age of 6 months. Results Serum levels of TLR-4 and TNF-α in preterm infants in both groups were significantly higher than those in term neonates (P <0.05). There was a positive correlation between serum TLR-4 and TNF-α, The difference was statistically significant (P <0.01). The levels of TLR-4 and TNF-α in the peripheral blood serum of the patients with abnormal CDCC at follow-up were significantly higher than those of normal controls (P <0.01). Conclusions Serum levels of TLR-4 and TNF-α in preterm infants are higher than those in term infants, suggesting that the activation of TLR-4 and TNF-α are closely related to the premature delivery of premature rupture of membranes and the motor mechanism of idiopathic premature labor. TLR -4, TNF-α, suggesting that TLR-4 may play an important role in promoting premature labor through activation of cytokine TNF-α as an upstream factor. The levels of TLR-4 and TNF-α in peripheral blood of premature infants can be used as an early indicator of prognosis of brain injury.