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目的探讨早产儿血清白细胞介素1β(IL-1β)和白细胞介素6(IL-6)水平变化及其与脑血流的关系。方法选择2010年10月至2011年10月我院新生儿重症监护病房收治、胎龄28~33周的单胎早产儿100例,根据是否发生脑室周围-脑室内出血(PIVH)分为观察组和对照组,并根据出血严重程度将观察组分为轻度组和重度组,全部研究对象均在生后第3天、第10天采血应用双夹心酶联免疫吸附法测定血清IL-1β和IL-6的浓度,同期进行头颅彩超检测收缩期血流速度与舒张末期血流速度比值(S/D值)和阻力指数(RI)。结果纳入的100例早产儿中77例发生PIVH,其中轻度组65例,重度组12例,未发生PIVH对照组23例。胎龄28~31周早产儿PIVH发生率与32~33周早产儿差异无统计学意义(P>0.05),但重度PIVH比例高于32~33周早产儿(27.6%比8.3%,P<0.05)。出生体重≤1500 g和1501~2000 g早产儿PIVH发生率高于>2000 g早产儿(90.0%、88.5%比46.4%,P<0.05),重度PIVH比例高于>2000 g早产儿(33.3%、4.3%比15.4%,P<0.05)。生后第3天重度组患儿血清IL-1β(μg/L)、IL-6(μg/L)及头颅彩超S/D值、RI水平高于轻度组和对照组[IL-1β:(90.1±7.4)比(42.7±4.0)、(16.5±4.7),IL-6:(102.5±8.2)比(55.3±7.2)、(20.2±4.4),S/D:(6.65±1.32)比(4.12±0.11)、(2.89±0.13),RI:(0.85±0.12)比(0.72±0.08)、(0.66±0.05),P<0.05];第10天,轻度组患儿血清IL-1β、IL-6及头颅彩超S/D值、RI水平已恢复至对照组水平(P>0.05),重度组患儿仍高于轻度组及对照组(P<0.05);轻度组及重度组生后第10天血清IL-1β、IL-6及头颅彩超S/D值、RI水平与第3天相比均明显降低(P<0.05)。PIVH患儿血清IL-1β、IL-6水平与S/D值、RI水平均呈正相关(r>0.5,P均<0.05)。结论血清IL-1β、IL-6水平与颅内出血病情及脑血流有关,动态监测血清IL-1β、IL-6水平有利于判断病情,指导临床诊治。
Objective To investigate the changes of serum interleukin-1β (IL-1β) and interleukin-6 (IL-6) in preterm infants and its relationship with cerebral blood flow. Methods From October 2010 to October 2011, 100 cases of singletonic preterm infants with gestational age of 28-33 weeks were admitted to our neonatal intensive care unit and were divided into observation group and control group according to whether peripheral ventriculoventricular hemorrhage (PIVH) occurred or not Control group, and according to the severity of bleeding, the observation group was divided into mild group and severe group. All the subjects were on the 3rd and 10th days after birth. Blood samples were collected for determination of serum IL-1β and IL by double-sandwich enzyme-linked immunosorbent assay -6, and the ratio of systolic to diastolic blood flow velocity (S / D) and resistance index (RI) were measured by skull color Doppler ultrasound in the same period. Results PIVH occurred in 77 of the 100 preterm infants. There were 65 cases in mild group and 12 cases in severe group, and 23 cases in PIVH control group. The incidence of PIVH in preterm infants with gestational age of 28-31 weeks was not significantly different from that of preterm infants in weeks 32-33 (P> 0.05), but the rate of severe PIVH was higher than that in preterm infants 32-33 weeks (27.6% vs. 8.3%, P < 0.05). The incidence of PIVH in preterm infants with birth weight ≤ 1500 g and 1501 ~ 2000 g was higher than that of> 2000 g premature infants (90.0%, 88.5% vs 46.4%, P <0.05) , 4.3% vs 15.4%, P <0.05). Serum levels of IL-1β, IL-6 (μg / L) and skull color Doppler ultrasound were significantly higher in the severe group than those in the mild group and the control group on the third day after birth [IL-1β: (90.1 ± 7.4) vs (42.7 ± 4.0), (16.5 ± 4.7), IL-6: (102.5 ± 8.2) vs (55.3 ± 7.2), (20.2 ± 4.4) (4.12 ± 0.11), (2.89 ± 0.13), RI: (0.85 ± 0.12) vs (0.72 ± 0.08), (0.66 ± 0.05), P <0.05; (P <0.05). The levels of RI and IL-6 in the severe group were still higher than those in the mild group and the control group (P <0.05) Serum levels of IL-1β, IL-6, skull ultrasound S / D, and RI were significantly decreased on the 10th day after birth (P <0.05) compared with those on the 3rd day. The levels of IL-1β and IL-6 in children with PIVH were positively correlated with S / D and RI (r> 0.5, P <0.05). Conclusion Serum levels of IL-1β and IL-6 are correlated with cerebral hemorrhage and cerebral blood flow. Dynamic monitoring of serum IL-1β and IL-6 levels is helpful for judging the disease and guiding clinical diagnosis and treatment.