【摘要】：目的：新生兒持續(xù)肺動脈高壓(PPHN)與成人特發(fā)性肺動脈高壓發(fā)病機制并不完全相同。高遷移率族蛋白B1(HMGB1)為炎癥反應中的細胞因子之一。成年特發(fā)性肺動脈高壓患者血清HMGB1水平升高,但PPHN中HMGB1的改變目前尚無文獻報道。本研究的目的是探討HMGB1在早期新生兒PPHN中的診斷意義。 方法：收集臨床資料完整日齡1周的新生兒共80例,分為足月正常兒臍血組(30例,正常臍血組)、近足月早產(chǎn)兒組(30例)和PPHN組(20例)(正常臍血組與近足月早產(chǎn)兒組均按1.5：1的比例進行分娩方式、胎齡、性別、出生體重配對,近足月早產(chǎn)兒組另外增加抽血時間點配對)。PPHN的確診參照第四版《實用新生兒學》。PPHN組患兒在確診后給予米力農(nóng)+常規(guī)治療,在米力農(nóng)+常規(guī)治療前(PPHN治療前組)、米力農(nóng)+常規(guī)治療24小時(PPHN治療后組)和米力農(nóng)停藥24小時(PPHN緩解組)三個時間點分別采血。血液檢驗指標為：HMGB1、腫瘤壞死因子α(TNF-α)和白細胞介素6(IL-6),以及動脈血氣、C反應蛋白(CRP)、降鈣素原(PCT)、血培養(yǎng)。HMGB1、TNF-α和IL-6的檢測均采用酶聯(lián)免疫吸附反應(ELISA)。 結(jié)果：1.正常臍血組、近足月早產(chǎn)兒組及PPHN治療前組血清HMGB1的濃度分別為(2.85±1.21)ng/ml、(8.74±2.60)ng/ml及(25.70±4.12)ng/ml,經(jīng)方差分析發(fā)現(xiàn)三組間差異具有統(tǒng)計學意義(F=52.354,P0.05)； 2.PPHN治療后組及PPHN緩解組血清HMGB1的濃度分別為(14.80±2.24)ng/ml和(4.64±1.06)ng/ml,經(jīng)獨立樣本t檢驗分析兩組差異具有統(tǒng)計學意義(t=18.306, P0.05); 3.PPHN患兒在給予臨床干預前血清HMGB1與TNF-α、IL-6水平之間互相呈顯著正相關(r=0.526、0.613,P0.05),但是與動脈血氧分壓及動脈血氧飽和度呈負相關(r=-0.957、-0.897,P0.05),與血CRP無相關性(r=0.232,P0.05)。 結(jié)論：血清HMGB1在早期新生PPHN明顯升高,并隨著病情的緩解而呈現(xiàn)降低的趨勢,動態(tài)監(jiān)測可幫助臨床診斷和判斷病情變化。圖4幅,表6個,參考文獻82篇。
[Abstract]:Objective: the pathogenesis of persistent pulmonary hypertension (PPHN) in neonates is not exactly the same as that of adult idiopathic pulmonary hypertension. High mobility group protein B1 (HMGB1) is one of the cytokines in inflammatory response. The level of serum HMGB1 in adult patients with idiopathic pulmonary hypertension increased, but the changes of HMGB1 in PPHN were not reported. The purpose of this study was to investigate the diagnostic significance of HMGB1 in early neonatal PPHN. Methods: a total of 80 newborns aged 1 week with complete clinical data were divided into two groups: umbilical cord blood group (30 cases). Normal cord blood group (n = 30), PPHN group (n = 20) and normal cord blood group (n = 30). The diagnosis of PPHN with reference to the fourth edition of "practical Neonatology". PPHN group was given routine treatment with milrinone after diagnosis. Blood samples were collected at three time points before conventional milrinone therapy (before PPHN treatment), 24 hours after milrinone therapy (PPHN group) and 24 hours after milrinone withdrawal (PPHN remission group). The blood test indexes were: 1: HMGB1, TNF- 偽 and IL-6, and arterial blood gas C-reactive protein (CRP), procalcitonin (PCT),. TNF- 偽 and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA). The result is 1: 1. The levels of serum HMGB1 were (2.85 鹵1.21) ng/ml, (8.74 鹵2.60) ng/ml and (25.70 鹵4.12) ng/ml, in normal umbilical cord blood group, proximal term premature infant group and PPHN group before treatment, respectively. The serum HMGB1 levels in 2.PPHN group and PPHN remission group were (14.80 鹵2.24) ng/ml and (4.64 鹵1.06) ng/ml, respectively, which were significantly higher than those in control group (t = 18.306, P0.05). There was a significant positive correlation between the two levels (P 0.05), but a negative correlation was found with the arterial partial pressure of oxygen and the arterial oxygen saturation (r = 0.957), but not with the blood CRP (r = 0.232, P 0.05). Conclusion: serum HMGB1 increased significantly in the early stage of neonatal PPHN and decreased with the remission of the disease. Dynamic monitoring can help clinical diagnosis and judge the change of the disease. 4 figures, 6 tables, 82 references.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R722.1

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