脐血TNF-α及IL-6水平在胎儿窘迫新生儿脑损伤诊断中的价值

摘要

目的 分析新生儿脐血白介素-6(IL-6)与肿瘤坏死因子-α(TNF-α)检测在胎儿窘迫新生儿脑损伤诊断的临床价值.方法 选取在深圳市盐田区人民医院妇产科于2013年1月至2014年12月发生宫内胎儿窘迫行剖宫产出生的新生儿60例,经脑核磁共振(MRI)检查显示存在脑损伤者25例(脑损伤组),无脑损伤者35例(无脑损伤组),另选择同期正常剖宫产分娩的20例新生儿(正常组)作为对照,胎儿娩出后立即采脐动脉血进行IL-6和TNF-α测定,进行ROC曲线分析,以研究IL-6和TNF-α对胎儿窘迫新生儿脑损伤的诊断价值.结果 3组新生儿血清IL-6、TNF-α水平比较均有显著性差异(F值分别为15.611、15.231,均P<0.01),进一步两两比较后发现,正常组新生儿与无脑损伤组新生儿血清IL-6及TNF-α水平比较均无显著性差异(t值分别为1.936、2.064,均P>0.05),而脑损伤组新生儿血清中IL-6、TNFα水平均显著高于正常组和无脑损伤组(t值分别为10.587、8.523、7.426、6.421,均P<0.05).IL-6和TNF-α对胎儿窘迫新生儿脑损伤的诊断价值进行ROC曲线分析得出,ROC曲线面积为0.84,0.50.05).However, the levels of serum IL-6 and TNF-αwere significantly higher in brain damage group than those of the normal group and no brain damage group (t value was 10.587, 8.523, 7.426 and 6.421, respectively, all P<0.05).ROC analysis of the diagnostic values of IL-6 and TNF-αon neonatal brain damage caused by fetal distress indicated that the ROC curve area was 0.84, and AUC ranged 0.5-1.0.The preceding result was of clinical value for the diagnosis of neonatal brain damage caused by fetal distress.When IL-6 level reached 156.22pg/mL, the diagnostic sensitivity for brain damage was 81.4%and specialty was 82.4%.Once TNF-αreached 53.22pg/mL, the diagnostic sensitivity for brain damage was 90.2%and specialty was 80.2%.Conclusion The detection of umbilical cord blood serum IL-6 and TNF-αlevel is of certain clinical value for the diagnosis of neonatal brain damage caused by fetal distress and can serve as a diagnostic indicator for the predication of neonatal brain damage.