目的 检测新生儿B族链球菌(group B streptococcus,GBS)感染所致化脓性脑膜炎(purulent meningitis,PM)血清中维生素D、白细胞介素(interleukin,IL)-6、IL-10、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和C反应蛋白(c-reactive protein,CRP)的表达水平,并探讨其临床价值.方法 选取2017年5月至2020年5月在秦皇岛市第一医院出生的59例GBS感染的PM新生儿纳入观察组,同期59例非GBS感染的PM新生儿(晚发败血症)纳入对照组.检测所有受试者血清维生素D、CRP、IL-6、IL-10和TNF-α 水平,并进行Pearson相关性分析;利用受试者操作特征(receiver operating characteristic,ROC)曲线分析血清维生素D和炎性细胞因子对新生儿GBS感染所致PM的诊断价值.统计学方法采用t检验、x2检验和Pearson相关性分析.结果 观察组与对照组孕产妇胎膜早破[47.5％(28/59)与5.1％(3/59),x2=27.345]、产时窒息[52.5％(31/59)与18.6％(11/59),x2=14.787]和产褥感染[(44.1％(26/59)与(22.0％(13/59)),x2=6.473]的发生率比较,观察组明显高于对照组(P<0.05).观察组血清维生素D水平显著低于对照组[(13.3±2.1)µg/L与(21.1±5.0)µg/L,t=11.345],IL-6[(87.1±14.5)µg/L与(63.9±11.9)µg/L,t=9.507]、IL-10[(49.6±15.2)µg/L与(29.3±10.0)µg/L,t=8.596]、TNF-α[(76.8±19.0)µg/L与(50.0±10.8)µg/L,t=9.410]和CRP[(21.5±5.0)µg/L与(13.7±3.7)µg/L,t=9.702]水平显著高于对照组(P值均<0.05).Pearson相关性分析结果显示,观察组血清维生素D水平分别与IL-6、IL-10、TNF-α和CRP水平呈负相关(r=-0.662、-0.644、-0.564、-0.643,P<0.05);血清维生素D、IL-6、IL-10、TNF-α 和CRP单独诊断GBS感染新生儿PM的曲线下面积(area under the curve,AUC)分别为0.831(95％CI:0.757～0.904)、0.887(95％CI:0.830～0.944)、0.859(95％CI:0.793～0.925)、0.888(95％CI:0.821～0.955)、0.879(95％CI:0.820～0.938),5项联合检测的AUC为0.991(95％CI:0.978～1.000).结论 GBS感染所致的PM新生儿血清中维生素D水平降低,炎性细胞因子水平增加,对于GBS感染所致的PM具有一定的辅助诊断价值.
Expression and significance of serum vitamin D and inflammatory cytokines in neonatal purulent meningitis caused by GBS infection
Objective To detect the expression levels of interleukin-6 (IL-6),interleukin-10 (IL-10),tumor necrosis factor (TNF-α) and C-reactive protein (CRP) in purulent meningitis (PM) caused by group B streptococcus (GBS) infection in neonates,and to discuss their clinical value.Method 59 PM newborns with GBS infection born in the First Hospital of Qinhuangdao from May 2017 to May 2020 were included in the observation group,and 59 PM newborns without GBS infection (late-onset sepsis) were included in the control group during the same period.The levels of serum vitamin D,CRP,IL-6,IL-10 and TNF-α were detected in all subjects,and Pearson correlation analysis was performed.The diagnostic value of serum vitamin D and inflammatory cytokines in PM neonates with GBS infection was analyzed by receiver operating characteristic (ROC) curve.The statistical methods performed by t-test,x2 test and Pearson correlation analysis.Result The pregnant women in the observation group had premature rupture of fetal membrane [47.5％ (28/59) and 5.1％ (3/59),x2=27.345],asphyxia during labor [52.5％ (31/59) vs 18.6％ (11/59)] and [(44.1％ (26/59) vs 22.0％ (13/59),x2=6.473] was significantly higher than that of the control group (P<0.05).Serum vitamin D level in the observation group was significantly lower than that in control group [(13.3±2.1)µg/L vs (21.1±5.0) µg/L,t=11.345].The observation group were significantly higher than those in control group in IL-6 [(87.1±14.5) µg/Land (63.9±11.9) µg/L,t=9.507],IL-10 [(49.6±15.2) µg/L and (29.3±10.0) µg/L,t=8.596],the TNF-α [(76.8±19.0) µg/L vs (50.0±10.8) µg/L,t=9.410] and CRP [(21.5±5.0) µg/L vs (13.7±3.7) µg/L,t=9.702] (P<0.05).The Pearson correlation analysis results showed that the serum vitamin D level in the observation group was negatively correlated with the levels of IL-6,IL-10,TNF-α and CRP,respectively (r=-0.662,-0.644,-0.564,-0.643,P<0.05).The area under the curve (AUC) of serum vitamin D,IL-6,IL-10,TNF-α and CRP in the alone diagnosis of neonatal PM with GBS infection were 0.831 (95％ CI: 0.757-0.904),0.887 (95％ CI: 0.830-0.944),0.859 (95％ CI: 0.793-0.925),0.888 (95％ CI: 0.821-0.955) and 0.879 (95％ CI: 0.820-0.938),respectively,and the AUC of five combined tests was 0.991 (95％ CI: 0.978-1.000).Conclusion Serum vitamin D levels of PM neonates caused by GBS infection decreased and inflammatory cytokine levels increased,which has certain auxiliary diagnostic value for PM caused by GBS infection.
Group B streptococcus infectionNeonatal purulent meningitisVitamin DInterleukin-6Interleukin-10Tumor necrosis factor-αC-reactive protein
万方数据
维普
