EPO治疗宫内感染早产儿脑损伤的疗效分析

Efficacy of EPO on Treatment of Intrauter-ine Infection in Preterm Infants with Brain Injury

摘要: 目的：探讨促红细胞生成素(EPO)治疗宫内感染致早产儿脑损伤中的疗效。方法：选择2017年6月至2017年12月于我院产科分娩的早产儿96例，对孕母胎盘、胎膜行病理检查，确定是否存在宫内感染(绒毛膜羊膜炎)；采用ELISA法测定早产儿血清中细胞因子IL-1β、IL-6、TNF-α、IL-10水平；早产儿生后3~7天行颅脑MRI，通过头颅影像学表现判断是否存在脑损伤；筛选出存在宫内感染并脑损伤的患儿给予EPO治疗，2周后再次检测血清细胞因子水平。结果：1) 脑损伤发生率：胎盘病理诊断为绒毛膜羊膜炎组为67.5% (27/40例)，无感染组为16.1% (9/56例)，比较两组脑损伤发生率，差异有统计学意义(P < 0.05)；2) 感染组血清IL-1β、IL-6、TNF-α、IL-10水平分别为(5.78 ± 1.31) μg/L、(7.62 ± 1.24) μg/L、(5.21 ± 1.14) μg/L、(1.18 ± 0.15) μg/L，与非感染组细胞因子比较，二者差异有统计学意义(P < 0.05)；3) 早产儿脑损伤组血清IL-1β、IL-6、TNF-α、IL-10水平分别为(6.17 ± 1.42) μg/L、(7.39 ± 1.17) μg/L、(5.54 ± 1.05) μg/L、(1.21 ± 0.12) μg/L，与无脑损伤组炎性细胞因子比较，二者差异有统计学意义(P < 0.05)；4) 宫内感染脑损伤组患儿经EPO治疗，血清细胞因子IL-1β、IL-6、TNF-α、IL-10分别为(3.40 ± 1.14) μg/L、(4.47 ± 1.34) μg/L、(3.59 ± 0.81) μg/L、(1.53 ± 0.16) μg/L，EPO治疗前后，血清细胞因子水平差异有统计学意义(P < 0.05)。结论 早产儿宫内感染易诱发脑损伤；细胞因子在宫内感染致早产儿脑损伤的病程中可能发挥重要作用；EPO干预在宫内感染致早产儿脑损伤过程中起到积极作用。

Abstract: Objective: To investigate the effect of postnatal EPO treatment on brain damage in premature infants caused by intrauterine infection. Methods: Ninety-six preterm infants delivered from June 2017 to December 2017 in our department of obstetrics were enrolled. The placenta of the pregnant mothers was examined for chorioamnionitis to determine whether there was intrau-terine infection. Enzyme-linked immunosorbent assay (ELISA) was used. The levels of cytokines IL-1β, IL-6, TNF-α, and IL-10 in serum of preterm infants were measured. Brain MRI was per-formed 3 - 7 days after birth in preterm infants. Brain imaging was performed to determine whether there was brain injury. Children with internal infection and brain injury were treated with EPO and serum cytokine levels were measured again after 2 weeks. Results: 1) The inci-dence of brain injury in children with placenta pathology diagnosed as chorioamnionitis was 67.5% (27/40 cases), and the prevalence of brain injury in non-chorionic amnion group was 16.1% (9/56 cases). The difference in prevalence was statistically significant (P < 0.05). 2) Se-rum levels of IL-1β, IL-6, TNF-α and IL-10 in the infected group were (5.78 ± 1.31) μg/L, (7.62 ± 1.24) μg/L, (5.21 ± 1.14) μg/L, (1.18 ± 0.15) μg/L, respectively. Compared with non-infected group, the difference was statistically significant (P < 0.05). 3) The levels of serum IL-1β, IL-6, TNF-α and IL-10 in the brain damage group of preterm infants were (6.17 ± 1.42) μg/L, (7.39 ± 1.17) μg/L, (5.54 ± 1.05) μg/L, (1.21 ± 0.12) μg/L, compared with the inflammatory cytokines without brain injury, the difference was statistically significant (P < 0.05). 4) The serum cyto-kines IL-1β, IL-6, TNF-α and IL-10 in children with intrauterine infection brain injury after EPO treatment were (3.40 ± 1.14) μg/L and (4.47 ± 1.34) μg/L, respectively. (3.59 ± 0.81) μg/L, (1.53 ± 0.16) μg/L, there was a significant difference in serum cytokine levels before and after EPO treatment (P < 0.05). Conclusions: Premature infants with intrauterine infection are prone to brain damage. Cytokines may play an important role in the process of brain injury induced by intrauterine infection in preterm infants. EPO intervention plays an active role in intrauterine infection of brain damage in preterm infants.