Application Value of IL-6, NES and Neonatal Craniocerebral UltrasoundIn Early Diagnosis of White Matter Injury in Premature Infants
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摘要:
目的 探究联合IL-6、NSE以及颅脑超声对早期诊断早产儿脑白质损伤的价值。 方法 选取昆明医科大学第二附属医院住院的早产儿300例作为研究对象，其中150例脑白质损伤早产儿为研究组，同期无脑白质损伤早产儿150例为对照组。研究时间为2018年1月至2020年1月，均于出生后的第1天、第3天与第7天行IL-6、NSE检查，并使用颅脑超声对其脑室周围的白质回声变化的灰度值进行监测，分析IL-6、NSE结合颅脑超声对早产儿脑白质损伤诊断的特异度、灵敏度与准确性，进行统计学分析。 结果 比较两组患儿出生后的第1天、第3天与第7天的颅脑诊断检出率，研究组均高于对照组，P < 0.05。比较两组患儿出生后的第1天、第3天与第7天的脑白质灰度值，研究组均高于对照组，P < 0.05。两组患儿出生后第1天、第3天与第7天的IL-6、NSE诊断结果，研究组均高于对照组，P < 0.05。参照头颅MRI作为金标准，颅脑超声联合IL-6、NSE的灵敏度为97.3%，特异度为95.4%，均优于IL-6、NSE，其优势卡方检验差异有统计学意义（P < 0.01）。 结论 三项联合诊断可以提高诊断有效性，IL-6、NSE以及颅脑超声对于诊断早产儿脑白质损伤均有意义，联合以上三种信息共同诊断，其灵敏度、特异度更高。 -
关键词:
- 脑白质损伤 /
- 白细胞介素-6 /
- 神经元特异性烯醇化酶 /
- 颅脑超声
Abstract:Objective To explore the value of combined IL-6, NSE and craniocerebral ultrasound in early diagnosis of white matter injury in premature infants in clinical practice. Methods The research objects of this study were 300 premature infants, 150 of whom were in the research group with white matter injury, and the early infants without white matter injury in the same period were in the control group. The duration of the study was from January 2018 to January 2020. IL-6 was tested in all preterm infants. NSE was diagnosed and the echo changes of white matter around the ventricle were observed by craniocerebral ultrasound. The specificity, sensitivity and accuracy of IL-6, NSE diagnosis were analyzed statistically. Results The detection rate of craniocerebral ultrasonography on day 1, day 3 and day 7 after birth was higher in the research group than in the control group （P < 0.05）. The gray value of craniocerebral heavy brain white matter on day 1, day 3 and day 7 after birth was compared between the two groups, the research group was all higher than the control group （P < 0.05）. Results of IL-6 and NSE on day 1, day 3 and day 7 after birth were compared between the two groups, the research group was higher than the control group （P < 0.05）. According to cranial MRI as the gold standard, the sensitivity and specificity of cranial ultrasound combined with IL-6 and NSE were 97.3% and 95.4%, both of which were superior to IL-6 and NSE, and the difference of the dominant chi-square test was statistically significant （P < 0.01）. Therefore, the three combined diagnoses could improve the diagnostic effectiveness. Conclusions IL-6, NSE and craniocerebral ultrasound are of significance for the diagnosis of white matter injury in premature infants. Combined with the above three kinds of information, the diagnosis has higher sensitivity, specificity and accuracy. -
Key words:
- White matter injury /
- Interleukin-6 /
- Neuron-specific enolase /
- Brain ultrasound
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表 1 PVL分度
Table 1. PVL dividing
分度 超声影像表现 Ⅰ度 一过性脑室周围白质回声增强，持续 > 7 d Ⅱ度 脑室周围白质回声增强，形成局灶性小囊腔 Ⅲ度 脑室周围白质回声增强，形成多灶性脑室周围囊性改变 Ⅳ度 广泛性白质回声増强，形成多灶性囊腔，皮层下也存在囊 
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表 2 颅脑诊断结果分析[n（%）]
Table 2. Analysis of craniocerebral diagnosis results [n（%）]
配对卡方检验 MRI + − 合计 US + 143（47.0） 4（1.30） 147（49.0） − 7（2.3） 146（48.7） 153（51.0） 合计 150（50.0） 150（50.0） 300（100.0） 统计结果 关联性检验 优势性检验 χ2 = 254.02 < 0.01 χ2 = 0.36 P = 0.549 注：配对卡方检验（关联卡方检验，优势卡方检验）。
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表 3 脑白质灰度值调查结果分析（
$\bar x \pm s $ ）Table 3. Analysis of the gray value of white matter survey results （
$\bar x \pm s $ ）组别 n 第1天 第3天 第7天 研究组 150 129.68 ± 9.94 129.98 ± 9.72 128.75 ± 9.34 对照组 150 96.82 ± 5.15 96.93 ± 4.66 97.34 ± 4.66 t / 18.5642 19.4559 19.0318 P / < 0.01 < 0.01 < 0.01
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表 4 血清IL-6数值结果分析（
$\bar x \pm s $ ）Table 4. Analysis the value of serum IL-6 （
$\bar x \pm s $ ）组别 n IL-6（ng/L） NSE（µg/L） 第1天 第3天 第7天 第1天 第3天 第7天 研究组 150 26.82 ± 4.51 25.37 ± 3.75 23.43 ± 3.82 9.37 ± 0.75 8.67 ± 0.75 8.52 ± 0.39 对照组 150 13.67 ± 2.89 13.52 ± 2.86 13.27 ± 2.69 3.88 ± 0.57 3.10 ± 0.27 2.87 ± 0.42 t / 15.5265 15.8913 13.7534 36.8589 44.1938 62.3463 P / < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01
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表 5 IL-6联合NSE与三项联合诊断的三维卡方检验数据[n（%）]
Table 5. Three-dimensional chi-square test data of combined diagnosis of IL-6, NSE and craniocerebral ultrasound [n（%）]
项目 +(真正阳性者) −(真正阴性者) US+IL−6+NSE US+IL−6+NSE +(阳性) −(阴性) 合计 +(阳性) −(阴性) 合计 IL-6+NSE +（阳性） 119（81.0） 1（0.7） 120(81.6) 2(1.3) 68(38.0) 70(45.8) −（阴性） 24（16.3） 3(20.4) 27（18.3） 5(3.3) 78(51.0) 83(54.2) 合计 143(97.3) 4(2.7） 147（100.0） 7(4.6) 146(95.4) 153(100.0)
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表 6 IL-6联合NSE与三项联合诊断的灵敏度、特异度分析
Table 6. Sensitivity and specificity analysis of IL-6 combined with NSE and three combined diagnosis
组别 灵敏度Sen 特异度Spe 误诊率α 漏诊率β 约登指数J 一致百分率 阳性似然比 阴性似然比 US+IL−6+NSE 0.973 0.954 0.046 0.027 0.927 0.96 21.1522 0.0283 IL−6+NSE 0.816 0.542 0.458 0.184 0.358 0.68 1.7817 0.3395 优势卡方 19.36 52.66 − − − − − − P < 0.01 < 0.01 − − − − − −
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