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中国循证儿科杂志

中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (1): 60-63.

• 论著 • 上一篇    下一篇

C-X3-C趋化因子配体1与新生儿中枢神经系统感染的相关性

李晓晓1,4，杨旻2,4，于翔3，周文浩1，汪吉梅2，胡黎园1   

  1. 1复旦大学附属儿科医院新生儿科，卫生部新生儿重点实验室 上海，201102；2 复旦大学附属妇产科医院新生儿科 上海，200090；3 中国科学院神经科学研究所 上海，200031；4 共同第一作者
  • 收稿日期:2017-01-13 修回日期:2017-02-13 出版日期:2017-02-25 发布日期:2017-02-25
  • 通讯作者: 汪吉梅，胡黎园

Study on the correlation between CX3CL1 and neonatal central nervous system infection

LI Xiao-xiao1,4, YANG Min2,4, YU Xiang3, ZHOU Wen-hao1, WANG Ji-mei2, HU Li-yuan1   

  1. 1 Department of Neonatology，Children＇s Hospital of Fudan University，Key Laboratory of the Ministry of Health Neonatal Diseases，Shanghai 201102，China; 2 Department od Neonatology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200090, China; 3 Shanghai Institutes for Biological Science, Chinese Academy of Sciences, Shanghai 200031, China
  • Received:2017-01-13 Revised:2017-02-13 Online:2017-02-25 Published:2017-02-25
  • Contact: WANG Ji-mei, HU Li-yuan

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摘要：

目的：探讨血浆或脑脊液中的C-X3-C趋化因子配体1（CX3CL1）是否可作为判断中枢神经系统感染的指标。方法：以2015年12月至2016年5月复旦大学附属儿科医院新生儿病房中疑诊中枢神经系统感染行腰椎穿刺检查的新生儿为感染组，根据临床表现，脑脊液常规、生化和培养结果分为中枢感染亚组、败血症亚组和非败血症亚组。以同一时期复旦大学附属妇产科医院产科病房健康新生儿为对照组，根据出生体重分为＜2 000 、 ~2 500 、~3 000 、~3 500 和＞3 500 g亚组，根据孕周分为＜33、~35、~37、~39和＞39周亚组。对照组取新生儿在出生后的脐带血；感染组于急性期或稳定期行腰椎穿刺检查，24 h后取静脉血标本。采用Luminex技术检测血或脑脊液标本中的CX3CL1水平，比较各组及其亚组间的差异。结果：对照组69例，感染组24例。中枢感染（化脓性脑膜炎）亚组8例，败血症亚组10例，非败血症亚组6例（脑积水2例，泌尿系统感染1例，新生儿惊厥2例、高胆红素血症伴食管气管瘘1例）。对照组脐血CX3CL1水平为（97.8±13.3）pg·mL-1，脐血CX3CL1水平在不同体重亚组以及不同孕周亚组间差异无统计学意义，P均＞0.05。 CX3CL1水平在感染组血浆 （95.1±8.2）pg·mL-1和对照组脐血比较差异无统计学意义（P=0.299）。CX3CL1水平感染组脑脊液中（210.0±11.9）pg·mL-1高于血浆，差异有统计学意义（P＜0.001）。感染组中的中枢感染亚组、败血症亚组和非败血症亚组脑脊液CX3CL1水平分别为（243.1±13.3）、（208.2±20.1）和（168.7±20.6）pg·mL-1，3组间差异有统计学意义（P=0.046）；中枢感染亚组与非败血症亚组比较，差异有统计学意义（P=0.016）； 败血症亚组与非败血症亚组比较（P=0.180）、中枢感染亚组与败血症亚组比较（P=0.169），差异均无统计学意义。结论：健康新生儿脐带血和感染新生儿外周血CX3CL1表达水平相对稳定，不适宜作为判断是否存在感染的指标，CSF中CX3CL1作为辅助诊断中枢感染和判断感染严重程度的分子标志物还需进一步扩大样本量加以证实。

Abstract:

Objective: To study C-X3-C chemokine ligand 1 (CX3CL1) in plasma or cerebrospinal fluid whether could be used as an biomaker of central nervous system infection. Methods: The plasma and CSF samples were collected from neonates who were suspected to have central nervous infection with lumbar puncture check admitted to Neonatal Ward of Children′s Hospital of Fudan University from December 2015 to May 2016, and they set for infection group, according to clinical manifestations, cerebrospinal fluid routine, biochemistry and culture results, they were divided into the central infection,sepsis and non-sepsis groups. At the same period healthy newborns cord blood samples were collected in the maternity ward of Obstetrics and Gynecology Hospital of Fudan University as a normal control group, and on the basis of birth weight group was divided into ＜ 2 000 g, -2 500 g, -3 000 g, -3 500 g, ＞3 500 g groups; and according to gestational age divided into ＜ 33 w, -35 w, -37 w, -39 w, ＞39 w groups. Using Luminex technology to detect CX3CL1 protein levels（Milliplex reagent kit HCYTOMAG-60K-06）,the differences between groups and subgroups were compared. Results: In 69 cases of control group, there were 24 cases with infection. There were 8 cases in central infection group (meningitis), 10 cases in sepsis group and 6 cases in non-sepsis subgroup (1 case with urinary tract infection, 2 cases with neonatal convulsion, 1 case with hyperbilirubinemia and esophageal tracheal fistula ). In the control group, CX3CL1 in cord blood was (97.8+. 13.3) pg·mL-1,there was no significant difference in cord blood CX3CL1 level among different body weight subgroups and different gestational weeks subgroups (P＞0.05). In infection group plasma CX3CL1 level ［（95.1±8.2）pg·mL-1］ had no significant difference from control group（t=-1.045,P=0.299）. There was significant difference in CX3CL1 level between plasma and cerebrospinal fluid, CX3CL1 level was significantly higher in cerebrospinal fluid（210.0±11.9）pg·mL-1 (P ＜ 0.001). Among central infection group, sepsis group and non-sepsis group cerebrospinal fluid CX3CL1 levels （243.1±13.3）pg·mL-1, （208.2±20.1）pg·mL-1and（168.7±20.6）pg·mL-1, there were significant differences （P=0. 046）; There were also significant differences in CX3CL1 levels in cerebrospinal fluid between central infection group and non-sepsis group （P=0.016）；There were no significant differences in CX3CL1 levels in cerebrospinal fluid between central infection group and sepsis group（P=0.180） or between sepsis group and non-sepsis group（P=0.169）.Conclusion: CX3CL1 level in plasma is relatively stable in the healthy newborns, CX3CL1 level in plasma can not be used to diagnose central nervous infection, CSF CX3CL1 levels may be an auxiliary biomarker for diagnosis of central nervous infection and its severity.