HMGB1对早期新生儿持续肺动脉高压诊断意义的研究

发布时间：2018-09-08 07:33

【摘要】：目的：新生儿持续肺动脉高压(PPHN)与成人特发性肺动脉高压发病机制并不完全相同。高迁移率族蛋白B1(HMGB1)为炎症反应中的细胞因子之一。成年特发性肺动脉高压患者血清HMGB1水平升高,但PPHN中HMGB1的改变目前尚无文献报道。本研究的目的是探讨HMGB1在早期新生儿PPHN中的诊断意义。方法：收集临床资料完整日龄1周的新生儿共80例,分为足月正常儿脐血组(30例,正常脐血组)、近足月早产儿组(30例)和PPHN组(20例)(正常脐血组与近足月早产儿组均按1.5：1的比例进行分娩方式、胎龄、性别、出生体重配对,近足月早产儿组另外增加抽血时间点配对)。PPHN的确诊参照第四版《实用新生儿学》。PPHN组患儿在确诊后给予米力农+常规治疗,在米力农+常规治疗前(PPHN治疗前组)、米力农+常规治疗24小时(PPHN治疗后组)和米力农停药24小时(PPHN缓解组)三个时间点分别采血。血液检验指标为：HMGB1、肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6),以及动脉血气、C反应蛋白(CRP)、降钙素原(PCT)、血培养。HMGB1、TNF-α和IL-6的检测均采用酶联免疫吸附反应(ELISA)。结果：1.正常脐血组、近足月早产儿组及PPHN治疗前组血清HMGB1的浓度分别为(2.85±1.21)ng/ml、(8.74±2.60)ng/ml及(25.70±4.12)ng/ml,经方差分析发现三组间差异具有统计学意义(F=52.354,P0.05)； 2.PPHN治疗后组及PPHN缓解组血清HMGB1的浓度分别为(14.80±2.24)ng/ml和(4.64±1.06)ng/ml,经独立样本t检验分析两组差异具有统计学意义(t=18.306, P0.05); 3.PPHN患儿在给予临床干预前血清HMGB1与TNF-α、IL-6水平之间互相呈显著正相关(r=0.526、0.613,P0.05),但是与动脉血氧分压及动脉血氧饱和度呈负相关(r=-0.957、-0.897,P0.05),与血CRP无相关性(r=0.232,P0.05)。结论：血清HMGB1在早期新生PPHN明显升高,并随着病情的缓解而呈现降低的趋势,动态监测可帮助临床诊断和判断病情变化。图4幅,表6个,参考文献82篇。
[Abstract]:Objective: the pathogenesis of persistent pulmonary hypertension (PPHN) in neonates is not exactly the same as that of adult idiopathic pulmonary hypertension. High mobility group protein B1 (HMGB1) is one of the cytokines in inflammatory response. The level of serum HMGB1 in adult patients with idiopathic pulmonary hypertension increased, but the changes of HMGB1 in PPHN were not reported. The purpose of this study was to investigate the diagnostic significance of HMGB1 in early neonatal PPHN. Methods: a total of 80 newborns aged 1 week with complete clinical data were divided into two groups: umbilical cord blood group (30 cases). Normal cord blood group (n = 30), PPHN group (n = 20) and normal cord blood group (n = 30). The diagnosis of PPHN with reference to the fourth edition of "practical Neonatology". PPHN group was given routine treatment with milrinone after diagnosis. Blood samples were collected at three time points before conventional milrinone therapy (before PPHN treatment), 24 hours after milrinone therapy (PPHN group) and 24 hours after milrinone withdrawal (PPHN remission group). The blood test indexes were: 1: HMGB1, TNF- 伪 and IL-6, and arterial blood gas C-reactive protein (CRP), procalcitonin (PCT),. TNF- 伪 and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA). The result is 1: 1. The levels of serum HMGB1 were (2.85 卤1.21) ng/ml, (8.74 卤2.60) ng/ml and (25.70 卤4.12) ng/ml, in normal umbilical cord blood group, proximal term premature infant group and PPHN group before treatment, respectively. The serum HMGB1 levels in 2.PPHN group and PPHN remission group were (14.80 卤2.24) ng/ml and (4.64 卤1.06) ng/ml, respectively, which were significantly higher than those in control group (t = 18.306, P0.05). There was a significant positive correlation between the two levels (P 0.05), but a negative correlation was found with the arterial partial pressure of oxygen and the arterial oxygen saturation (r = 0.957), but not with the blood CRP (r = 0.232, P 0.05). Conclusion: serum HMGB1 increased significantly in the early stage of neonatal PPHN and decreased with the remission of the disease. Dynamic monitoring can help clinical diagnosis and judge the change of the disease. 4 figures, 6 tables, 82 references.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R722.1

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