胎盘炎症及胎儿炎症反应综合征与早产儿脑损伤的关系研究

目的 探讨胎盘组织学绒毛膜羊膜炎(HCA)及胎儿炎症反应综合征(FIRS)与早产儿脑损伤的关系。方法 选取胎龄34 周以下并伴有胎膜早破(PROM)的单胎早产儿103 例,分为HCA-FIRS-、HCA+FIRS-、HCA+FIRS+ 等3 组,采用液相芯片分析技术检测脐血IL-6、IL-8、肿瘤坏死因子-α(TNF-α)、粒细胞集落刺激因子(G-CSF)水平。结果 HCA 发生率、FIRS 及脑损伤发生率分别为53.4%、20.4%、38.8%。HCA-FIRS-、HCA+FIRS-、HCA+FIRS+ 组脑损伤发生率分别为21%、41% 和76%(P<0.01)。胎盘2 级和3 级炎症及炎症的2 期和3 期均是早产儿脑损伤的危险因素(P<0.01)。HCA+FIRS+ 组IL-8、TNF-α 及G-CSF 水平明显高于另外2 组,且HCA+FIRS- 高于 HCA-FIRS- 组(P<0.05)。结论 胎盘炎症合并FIRS 与早产儿脑损伤密切相关,且胎盘炎症程度越重、进展越快,早产儿脑损伤发生风险越高。IL-8、TNF-α 及G-CSF 可能在胎盘炎症合并FIRS 的早产儿脑损伤发生过程中起重要介导作用。

Relationship between placental inflammation and fetal inflammatory response syndrome and brain injury in preterm infants

Objective To explore the relationship between histological chorioamnionitis (HCA) and fetal inflammatory response syndrome (FIRS) and brain injury in preterm infants. Methods One hundred and three singleton infants with premature rupture of membranes (PROM) (gestation ages of less than 34 weeks) were enrolled. All the placentas were submitted for pathological evaluation. Umbilical cord blood interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNF-α) and granulocyte-colony stimulating factor (G-CSF) levels were measured with liquid chip. All preterm infants accepted brain imaging examinations. Based on the placental pathological examination and umbilical cord blood level of IL-6, the 103 infants were classified into HCA^- FIRS^-, HCA⁺ FIRS^-, and HCA⁺ FIRS⁺ groups. Results The incidences of HCA, FIRS, and brain injury were 53.4%, 20.4% and 38.8% respectively. The prevalence of brain injury in HCA^- FIRS^-, HCA⁺ FIRS^-, and HCA⁺ FIRS⁺ cases was 21%, 41%, and 76% respectively (P<0.01). The grade 2 and grade 3 of placental inflammation and the inflammation at stage 2 and stage 3 increased the risk of brain injury. The cord blood levels of IL-8, TNF-α, and G-CSF in the HCA⁺ FIRS⁺ group were significantly higher than in the other two groups, and the levels of the above parameters in the HCA⁺ FIRS^- were higher than in the HCAFIRS^- group (P<0.05). Conclusions Placental inflammation and FIRS are associated with brain injury in preterm infants. Preterm infants exposed to severe placental inflammation have an increased risk of brain injury. Cord blood IL- 8, TNF-α and G-CSF may be involved in the process of brain injury in preterm infants with placental inflammation and FIRS.