Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany.
Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
Am J Physiol Lung Cell Mol Physiol. 2021 Dec 1;321(6):L1036-L1043. doi: 10.1152/ajplung.00176.2021. Epub 2021 Sep 29.
Invasive mechanical ventilation and oxygen toxicity are postnatal contributors to chronic lung disease of prematurity, also known as bronchopulmonary dysplasia (BPD). Cyfra 21-1 is a soluble fragment of cytokeratin 19, which belongs to the cytoskeleton stabilizing epithelial intermediate filaments. As a biomarker of structural integrity, Cyfra 21-1 might be associated with airway injury and lung hypoplasia in neonates. Serum Cyfra 21-1 concentrations for 80 preterm and 80 healthy term newborns were measured within 48 h after birth. Preterm infants with the combined endpoint BPD/mortality had significantly higher Cyfra 21-1 levels compared with those without fulfilling BPD/mortality criteria ( = 0.01). Also, severe RDS (>grade III) was associated with higher Cyfra levels ( = 0.01). Total duration of oxygen therapy was more than five times longer in neonates with high Cyfra 21-1 levels ( = 0.01). Infants with higher Cyfra 21-1 values were more likely to receive mechanical ventilation (50% vs. 17.5%). However, the duration of mechanical ventilation was similar between groups. The median Cyfra value was 1.93 ng/mL (IQR: 1.68-2.53 ng/mL) in healthy term neonates and 8.5 ng/mL (IQR: 3.6-16.0 ng/mL) in preterm infants. Using ROC analysis, we calculated a Cyfra cutoff > 8.5 ng/mL to predict BPD/death with an AUC of 0.795 ( = 0.004), a sensitivity of 88.9%, and a specificity of 55%. Mortality was predicted with a cutoff > 17.4 ng/mL (AUC: 0.94; = 0.001), a sensitivity of 100%, and a specificity of 84%. These findings suggest that Cyfra 21-1 concentration might be useful to predict poor outcome in premature infants.
在早产儿慢性肺病（也称为支气管肺发育不良，BPD）中，有创机械通气和氧毒性是产后的致病因素。细胞角蛋白 19 的可溶性片段 Cyfra 21-1 属于细胞骨架稳定的上皮中间丝。作为结构完整性的生物标志物，Cyfra 21-1 可能与新生儿的气道损伤和肺发育不全有关。在出生后 48 小时内，测量了 80 名早产儿和 80 名健康足月儿的血清 Cyfra 21-1 浓度。与未满足 BPD/死亡率标准的早产儿相比，具有联合终点 BPD/死亡率的早产儿的 Cyfra 21-1 水平显著更高（ = 0.01）。此外，严重的 RDS（> 3 级）与更高的 Cyfra 水平相关（ = 0.01）。高 Cyfra 21-1 水平的新生儿需要接受氧气治疗的总时间延长了五倍以上（ = 0.01）。Cyfra 21-1 值较高的婴儿更有可能接受机械通气（50%对 17.5%）。然而，两组之间的机械通气持续时间相似。健康足月新生儿的 Cyfra 中位数为 1.93ng/ml（IQR：1.68-2.53ng/ml），早产儿为 8.5ng/ml（IQR：3.6-16.0ng/ml）。使用 ROC 分析，我们计算出 Cyfra 截断值> 8.5ng/ml 预测 BPD/死亡的 AUC 为 0.795（ = 0.004），敏感性为 88.9%，特异性为 55%。使用截断值> 17.4ng/ml 预测死亡率（AUC：0.94； = 0.001），敏感性为 100%，特异性为 84%。这些发现表明，Cyfra 21-1 浓度可能有助于预测早产儿的不良预后。
