【摘要】 目的分析新生儿脐血白介素-6(IL-6)与肿瘤坏死因子-α(TNF-α)检测在胎儿窘迫新生儿脑损伤诊断的临床价值。方法选取在深圳市盐田区人民医院妇产科于2013年1月至2014年12月发生宫内胎儿窘迫行剖宫产出生的新生儿60例,经脑核磁共振(MRI)检查显示存在脑损伤者25例(脑损伤组),无脑损伤者35例(无脑损伤组).另选择同期正常剖宫产分娩的20例新生儿(正常组)作为对照,胎儿娩出后立即采脐动脉血进行IL-6和TNF-α测定,进行ROC曲线分析,以研究IL-6和TNF-α对胎儿窘迫新生儿脑损伤的诊断价值。结果 3组新生儿血清IL-6、TNF-α水平比较均有显著性差异(F值分别为15.611、15.231,均p<0.01),进一步两两比较后发现,正常组新生儿与无脑损伤组新生儿血清IL-6及TNF-α水平比较均无显著性差异(t值分别为1.936、2.064,均P>0.05),而脑损伤组新生儿血清中IL-6、TNFα水平均显著高于正常组和无脑损伤组(t值分别为10.587、8.523、7.426、6.421,均P<0.05)。IL-6和TNF-α对胎儿窘迫新生儿脑损伤的诊断价值进行ROC曲线分析得出,ROC曲线面积为0.84,0.5<AUC<1.0,对胎儿窘迫新生儿脑损伤具有临床诊断价值;当IL-6水平在156.22pg/mL时,诊断脑损伤的灵敏度为81.4%,特异度为82.4%;当TNF-α水平在53.22pg/mL时,诊断脑损伤的灵敏度为90.2%,特异度为80.2%。结论脐血血清中IL-6及TNF-α的检测对诊断胎儿窘迫新生儿脑损伤具有一定的临床价值,可作为预测新生儿脑损伤的诊断指标。更多还原

【Abstract】 Objective To investigate the clinical value of neonatal umbilical cord blood interleukin(IL-6) and blood tumor necrosis factor alpha(TNF-α) detection for the diagnosis of neonatal brain damage caused by fetal distress.Methods A total of 60 cases of neonates who underwent cesarean delivery due to fetal distress were selected as research objects.All of those neonates were delivered at the department of obstetrics and gynecology in Shenzhen Yantian District People’s Hospital from January 2013 to December 2014.MRI results indicated that25 cases had brain damage(brain damage group) while the other 35 cases were free from brain damage(no brain damage group).In addition,a total of 20 cases of neonates(normal group),who underwent normal caesarean section at the same period were selected as control group.Umbilical artery blood was collected to determine IL-6 and TNF-α level.In addition,ROC analysis was performed to explore the diagnostic value of IL-6 and TNF-α on neonatal brain damage caused by fetal distress.Results Significant inter-group differences were identified in serum IL-6 and TNF-α levels among neonates in three groups(F value was 15.611 and 15.231 respectively,both P <0.01).Pairwise comparisons showed that there was no significant difference in serum IL-6 and TNF-α levels between neonates in normal group and no brain damage group(t value was 1.936 and 2.064 respectively,both P>0.05).However,the levels of serum IL-6 and TNF-α were significantly higher in brain damage group than those of the normal group and no brain damage group(t value was 10.587,8.523,7.426 and 6.421,respectively,all P < 0.05).ROC analysis of the diagnostic values of IL-6 and TNF-α on neonatal brain damage caused by fetal distress indicated that the ROC curve area was 0.84,and AUC ranged 0.5-1.0.The preceding result was of clinical value for the diagnosis of neonatal brain damage caused by fetal distress.When IL-6 level reached 156.22pg/mL,the diagnostic sensitivity for brain damage was 81.4%and specialty was 82.4%.Once TNF-α reached 53.22pg/mL,the diagnostic sensitivity for brain damage was 90.2%and specialty was 80.2%.Conclusion The detection of umbilical cord blood serum IL-6 and TNF-α level is of certain clinical value for the diagnosis of neonatal brain damage caused by fetal distress and can serve as a diagnostic indicator for the predication of neonatal brain damage.更多还原