Varner Michael W, Marshall Nicole E, Rouse Dwight J, Jablonski Kathleen A, Leveno Kenneth J, Reddy Uma M, Mercer Brian M, Iams Jay D, Wapner Ronald J, Sorokin Yoram, Thorp John M, Malone Fergal D, Carpenter Marshall, O'Sullivan Mary J, Peaceman Alan M, Hankins Gary D V, Dudley Donald J, Caritis Steve N
Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.
Am J Perinatol. 2015 Feb;30(2):115-22. doi: 10.1055/s-0034-1376185. Epub 2014 Jun 17.
To test whether elevated umbilical cord serum inflammatory cytokine levels predicted subsequent cerebral palsy (CP) or neurodevelopmental delay (NDD).
Nested case-control analysis within a clinical trial of antenatal magnesium sulfate (MgSO4) before anticipated preterm birth (PTB) for prevention of CP, with evaluation of surviving children at the age of 2. NDD was defined as a Bayley psychomotor developmental index (PDI) and/or mental developmental index (MDI) < 70. Controls, defined as surviving children without CP and with Bayley PDI and MDI ≥ 85, were matched by race and gestational age. Cord serum was analyzed for interleukin-8 (IL-8) interleukin-1 beta (IL-1β), and tumor necrosis factor-α (TNF-α) levels. Elevated cytokine levels were defined as ≥ 75th percentile in placebo-exposed controls. Analyses compared case/control cytokine levels, adjusting for MgSO4 exposure, gestational age, race/ethnicity, and sociodemographic differences.
Logistic regression analysis with 339 cases and 276 controls showed that elevated IL-8 and IL-1β were more common in cord blood serum from infants with subsequent low MDI as compared with controls. After adjusting for additional confounders, the significant differences were no longer evident. Cytokine levels (IL-8, IL-1β, and TNF-α) were not elevated with CP or low PDI.
Cord serum IL-8, IL-1β, and TNF-α levels in preterm infants are not associated with subsequent CP or NDD.
检测脐带血清炎症细胞因子水平升高是否可预测随后发生的脑瘫（CP）或神经发育迟缓（NDD）。
在一项关于产前硫酸镁（MgSO4）预防预期早产（PTB）后CP的临床试验中进行巢式病例对照分析，并对2岁时存活的儿童进行评估。NDD定义为贝利心理运动发育指数（PDI）和/或智力发育指数（MDI）<70。对照组定义为无CP且贝利PDI和MDI≥85的存活儿童，按种族和胎龄进行匹配。分析脐带血清中的白细胞介素-8（IL-8）、白细胞介素-1β（IL-1β）和肿瘤坏死因子-α（TNF-α）水平。细胞因子水平升高定义为在暴露于安慰剂的对照组中≥第75百分位数。分析比较了病例/对照的细胞因子水平，并对MgSO4暴露、胎龄、种族/民族和社会人口统计学差异进行了校正。
对339例病例和276例对照进行的逻辑回归分析显示，与对照组相比，随后MDI较低的婴儿脐带血血清中IL-8和IL-1β升高更为常见。在对其他混杂因素进行校正后，显著差异不再明显。CP或低PDI时细胞因子水平（IL-8、IL-1β和TNF-α）未升高。
早产儿脐带血清IL-8、IL-1β和TNF-α水平与随后发生的CP或NDD无关。
