| Background and objectiveWith the development of perinatal medical,the survival rate of premature infants,especially the very low birth weight infants,has improved significantly,but the incidence of bronchopulmonary dysplasia(BPD)has not decreased,and has been increasing conversly.Foreign literature show that the incidence of BPD is 50%in ultra-low birth weight and very premature infants.BPD can deteriorate the prognosis and quality of life of premature infants.The readmission rate of BPD is great more than 50%that of non-BPD in the first year after birth,with the worse long-term prognosis of more respiratory and neurological complications.The pathogenesis of BPD is very complicated,but it is not explicit up to now.Research shows inflammation,hypoxia,hyperoxia and toxins might be associated with the higher level of Heme oxygenase-1(HO-1).Mono-cyte chemoattractant protein-4(MCP-4)can induce eosinophils to gather in the inflammatory site,produce cytotoxic related proteins and promote the inflammatory response.In this study,we analyzed the changes of HO-1 and MCP-4 level in the serum of preterm infants in the early postnatal period,and discussed the significance of HO-1 and MCP-4 and the occurrence of BPD,which may provide an avenue to improve the therapeutic precision of BPD in premature infants.MethodsThere were 256 premature infants who were admitted to the neonatal ward of The Third Affiliated Hospital of ZhengZhou University with gestational age?32 weeks and birth weight ? 1500g from January 01,2019 to December 31,2019,and the medical record information of the children was collected.The infants were divided into BPD group and non-BPD group according to whether BPD occurred 28 days after birth,furthermore the BPD group was divided into mild group and moderate/severe group according to the oxygen therapy of premature infants with BPD.And 2 ml of peripheral venous blood samples were collected from preterm infants at birth and 14th day of birth from the 256 premature infants,finally 60 premature infants in the non-BPD group with no differences in the general condition of the pregnant mother,the birth condition and the general condition of the infants were selected.And use enzyme linked immunosorbent assay(ELISA)to detect the serum levels of HO-1 and MCP-4,and the changes of serum levels in different groups were compared.Results1.General condition:A total of 256 children were included,there were 66 cases in the BPD group,with a morbidity of 25.8%,including 38 cases in the mild group(57.1%),28 cases in the moderate to severe group(42.9%);and 190 cases were in non-BPD group.There were 42 males(63.6%)in the BPD group,and 99 males(52.1%)in the non-BPD group,there was no significant difference between the two groups(P>0.05),The gestational age(29.2 ±1.5)weeks and the average birth weight(1168.0±232.1)g in the BPD group were lower than(30.0±1.2)weeks and(1259.1±175.8)g in the non-BPD group,and the differences in two groups were statistically significant(P<0.05).2.There was no statistical difference between the rate of cesarean section(54.5%),premature rupture of membranes(31.8%),preeclampsia(28.8%),gestational diabetes(9.1%)in the BPD group and the non-BPD group(50.0%?22.1%?34.7%?14.2%)(P>0.05);The 1-minute Apgar score(7.3±1.6)and 5-minute Apgar score(8.2±1.3)of the BPD group were lower than those of the non-BPD group[(7.8±1.5)and(8.8 ±1.0)],the differences were statistically significant(P<0.05);the neonatal pneumonia(72.7%),neonatal respiratory distress syndrome grade III-IV(27.3%),neonatal asphyxia(43.9%),and patent ductus arteriosus(60.6%)of the BPD group were all higher than those of the non-BPD group(27.4%,10.5%,27.4%,38.9%),the differences were statistically significant(P<0.05);The mechanical ventilation time 0(0,7.2)d,CPAP time 13(7,22)d,total oxygen therapy time 36(30,46.3)d,and hospital stay time 49(39,59)d in the BPD group were higher than those[0(0,0)d,7(4,10.3)d,14.4(9,26.3)d,39(32,48)d]in the non-BPD group,the differences were statistically significant(P<0.05).3.Comparison of HO-1 levels between BPD group and non-BPD group and different levels of BPD group:The level of HO-1 in serum of children in the BPD group on the 14th day was higher than that in the non-BPD group[(17.4±4.2)ng/ml vs(7.8±4.3)ng/ml],the difference was statistically significant(P<0.05);while the difference of serum HO-1 level at birth[(11.3±3.9)ng/ml vs(10.2±2.7)ng/ml]between two groups was not statistically significant(P>0.05);the level of serum HO-1(19.3±4.2)ng/ml on 14st day after birth in the moderate/severe BPD group was significantly higher than that in the mild BPD group(16.7±3.9)ng/ml,the difference was statistically significant(P<0.05),while the difference of serum HO-1 level at birth[(12.0±4.1)ng/ml vs(10.9±3.7)ng/ml]between two groups was not statistically significant(P>0.05).4.Comparison of MCP-4 levels between BPD group and non-BPD group and different levels of BPD group:The levels of MCP-4 in serum of children in the BPD group on the 14th day was higher than that in the non-BPD group[(240.9±46.2)pg/ml vs(146.9±63.8)pg/ml],the difference was statistically significant(P<0.05);while the difference of serum HO-1 level at birth[(174.8±70.8)pg/ml vs(150.4±68.2)pg/ml]between two groups was not statistically significant(P>0.05);the differences of MCP-4 in serum of children with moderate/severe BPD group and mild BPD group at birth and 14th day[(191.6±71.6)pg/ml vs(162.4±68.4)pg/ml,(251.1±46.8)pg/ml vs(232.1±45.5)pg/ml]were not statistically significant(P>0.05).5.Analysis of high risk factors for BPD:Logistic regression analysis showed that birth weight(OR=1.004,95%CI=1.001?1.007),total oxygen therapy time(OR=1.170,95%CI=1.105?1.238),PDA(OR=0.198,95%CI=0.062?0.636)?antibiotic use time within 14 days after birth(OR=1.154,95%CI=1.025?1.299)were risk factors for bronchopulmonary dysplasia in preterm infants(P<0.05).ConclusionsThere is a certain relationship between serum HO-1 in preterm infants and the severity of BPD.HO-1 and MCP-4 may be involved in the development of BPD in the early postnatal period,which has certain implications for predicting the occurrence of BPD. |
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