全身性胎儿炎症反应与支气管肺发育不良的发生

A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia.

作者信息

Yoon B H, Romero R, Kim K S, Park J S, Ki S H, Kim B I, Jun J K

机构信息

Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Korea.

出版信息

Am J Obstet Gynecol. 1999 Oct;181(4):773-9. doi: 10.1016/s0002-9378(99)70299-1.

DOI:10.1016/s0002-9378(99)70299-1

PMID:10521727

Abstract

OBJECTIVE

The purpose of this study was to test the hypothesis that a systemic fetal inflammatory response is a risk factor for the subsequent development of bronchopulmonary dysplasia in preterm neonates.

STUDY DESIGN

The relationship between interleukin 6 concentrations in umbilical cord plasma at birth and the occurrence of bronchopulmonary dysplasia was examined in 203 preterm births (25-34 weeks). Ninety-six patients underwent transabdominal amniocentesis within 5 days of birth. The relationship between umbilical cord plasma interleukin 6 concentration and bronchopulmonary dysplasia was compared with the relationship between amniotic fluid interleukin 6 concentration and bronchopulmonary dysplasia. Interleukin 6 was measured by specific immunoassay. Logistic regression was used for statistical analysis.

RESULTS

Bronchopulmonary dysplasia was diagnosed in 17% (34/203) of the infants. Neonates in whom bronchopulmonary dysplasia developed had a significantly higher median interleukin 6 concentration in umbilical cord plasma at birth than did those in whom bronchopulmonary dysplasia did not develop (median, 68.3 pg/mL and range, 0.3-6150.0 pg/mL vs median, 6.9 pg/mL and range 0-19,230.0 pg/mL; P <.001). This difference remained significant after adjustment for gestational age at birth (odds ratio, 4.2; 95% confidence interval, 1.6-11.2). Logistic regression analysis indicated that an elevated umbilical cord plasma interleukin 6 concentration was a better predictor of the development of bronchopulmonary dysplasia than was an elevated amniotic fluid interleukin 6 concentration (P <.005).

CONCLUSION

An elevated interleukin 6 concentration in umbilical cord plasma at birth is an independent risk factor for the development of bronchopulmonary dysplasia. These data support the concept that the injury responsible for bronchopulmonary dysplasia in a subset of neonates may begin before birth and is associated with the development of a fetal systemic inflammatory response, as determined by plasma concentrations of interleukin 6.

摘要

目的

本研究旨在验证以下假设，即全身性胎儿炎症反应是早产新生儿随后发生支气管肺发育不良的危险因素。

研究设计

对203例早产（25 - 34周）病例，检测出生时脐带血浆中白细胞介素6浓度与支气管肺发育不良发生情况之间的关系。96例患者在出生后5天内接受了经腹羊膜腔穿刺术。将脐带血浆白细胞介素6浓度与支气管肺发育不良的关系，与羊水白细胞介素6浓度与支气管肺发育不良的关系进行比较。采用特异性免疫测定法检测白细胞介素6。使用逻辑回归进行统计分析。

结果

17%（34/203）的婴儿被诊断为支气管肺发育不良。发生支气管肺发育不良的新生儿出生时脐带血浆中白细胞介素6的中位浓度显著高于未发生支气管肺发育不良的新生儿（中位数分别为68.3 pg/mL，范围0.3 - 6150.0 pg/mL；与中位数6.9 pg/mL，范围0 - 19,230.0 pg/mL相比；P <.001）。在对出生时的胎龄进行校正后，这种差异仍然显著（比值比，4.2；95%置信区间，1.6 - 11.2）。逻辑回归分析表明，脐带血浆白细胞介素6浓度升高比羊水白细胞介素6浓度升高更能预测支气管肺发育不良的发生（P <.005）。