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目的观察HIE患儿血清IL-6、IL-18水平变化,探讨二者在判断HIE的程度和预后中的价值。方法采用ELISA检测42例HIE患儿(轻度HIE组24例,中度HIE组10例,重度HIE组8例)及20例健康新生儿(健康对照组)出生第1天、第7天血清IL-6、IL-18水平,并于出生第7天行新生儿神经行为测定(NBNA)。比较各组儿童血清IL-6、IL-18水平及NBNA评分的差异,建立受试者工作曲线(ROC曲线),同时分析不同截断值的敏感度、特异度、阳性和阴性预测值。结果 1.轻度HIE组、中度HIE组、重度HIE组IL-6与IL-18水平均较健康对照组显著升高(Pa<0.01);IL-6与IL-18水平随脑损伤程度加重而增加,3个HIE组比较差异有统计学意义(Pa<0.01);NBNA评分随HIE程度加重而降低,除健康对照组与轻度HIE组比较差异无统计学意义(P>0.05),余各组间比较差异均有显著性意义(Pa<0.01)。2.各组HIE患儿出生第7天血清IL-6、IL-18水平较出生第1天均有明显下降,各组间比较均有统计学差异(Pa<0.01)。3.当IL-6>83.45 ng.L-1时,其敏感度、特异度、阳性预测值及阴性预测值分别为86.8%、74.6%、76.7%、84.9%;当IL-18>600.36 ng.L-1时,其敏感度、特异度、阳性预测值及阴性预测值分别为89.2%、86.8%、87.1%、89.2%。结论动态监测IL-6、IL-18水平变化可作为HIE患儿早期诊断及预后判断的指标之一。
Objective To observe the changes of serum IL-6 and IL-18 levels in children with HIE and to explore their value in judging the extent and prognosis of HIE. Methods Twenty-four HIE infants (24 in mild HIE group, 10 in moderate HIE group, 8 in severe HIE group) and 20 healthy newborns (healthy control group) were detected by ELISA on day 1 and day 7 IL-6, IL-18 levels, and neonatal neurobehavioral testing (NBNA) on day 7 of birth. The differences of serum IL-6, IL-18 levels and NBNA scores between the two groups were compared to establish the working curve (ROC curve) of the subjects, and the sensitivity, specificity, positive and negative predictive values were also analyzed. The levels of IL-6 and IL-18 in mild HIE group, moderate HIE group and severe HIE group were significantly higher than those in healthy control group (P <0.01). The levels of IL-6 and IL-18 were positively correlated with the level of brain injury (P <0.01). The NBNA score decreased with the increase of HIE level, except for the difference between the healthy control group and the mild HIE group (P> 0.05), but no significant difference between the three HIE groups The remaining differences between the groups were significant (Pa <0.01). The levels of IL-6 and IL-18 in serum on the 7th day after birth in HIE group were significantly lower than those on the 1st day of birth, and the difference was statistically significant (P <0.01). The sensitivity, specificity, positive predictive value and negative predictive value of IL-6> 83.45 ng.L-1 were 86.8%, 74.6%, 76.7%, 84.9% .L-1, the sensitivity, specificity, positive predictive value and negative predictive value were 89.2%, 86.8%, 87.1%, 89.2% respectively. Conclusions Dynamic monitoring of IL-6 and IL-18 levels may be one of the indicators of early diagnosis and prognosis in children with HIE.