目的 探讨早产儿脐血血清中Clara细胞分泌蛋白(CCSP)水平与支气管肺发育不良(BPD)的关系, 以期为BPD的早期预测提供依据。方法 收集2019年1-5月山东省妇幼保健院新生儿重症监护室收治的早产儿105例, 出院后根据出院诊断将其分为3组: NRDS组22例, BPD组20例, 对照组63例。采用酶联免疫吸附试验(ELISA)方法检测脐血血清中CCSP水平。比较3组患儿脐血血清中CCSP水平, 分析CCSP在早产儿BPD的诊断效能及与胎龄、体重的相关性。采用方差分析及χ²检验、相关性分析等进行统计分析。结果 BPD组患儿脐血中CCSP水平(20.332±8.066)ng/ml, 与对照组(46.237±19.991)ng/ml和NRDS组(33.132±10.132)ng/ml比较差异有统计学意义(F=19.926, P<0.001), LSD检验两两比较, 对照组与NRDS组的CCSP水平均高于BPD组, 差异有统计学意义(P<0.05)。胎龄、出生体重与早产儿脐血中CCSP水平成正相关(r=0.533、0.550, P<0.01)。截断值为31.560 ng/ml时诊断效能最大, 约登指数为0.582, 灵敏度90.0％, 特异度68.2％。受试者工作特征曲线(ROC)下面积0.886(95%CI: 0.814~0.957, P<0.01)。结论 早产儿脐血CCSP低浓度可能反应早期肺损伤, 与BPD的发生有关, 可以作为预测BPD的潜在标志物。

Objective To investigate the relationship between Clara cell secretory protein (CCSP) and bronchopulmonary dysplasia (BPD) in premature infants, in order to provide reference for early prediction of BPD. Methods Totally 105 premature infants were enrolled in this study from the Neonatal Intensive Care Unit of Maternal and Child Health Care Hospital of Shandong Province from January to May in 2019.After discharge, the infants were divided into three groups according to the discharge diagnosis, including NRDS group (n=22), BPD group (n=20) and control group (n=63).The level of CCSP in cord blood serum was tested by enzyme-linked immunosorbent assay (ELISA).The level of CCSP in cord blood serum among three groups was compared, and the diagnostic efficacy of CCSP in BPD of premature infants as well as its correlation with gestational age and body weight were analyzed.Variance analysis, χ² test and correlation analysis were used for statistical analysis. Results Compared with the control group [(46.237±19.991) ng/ml] and the NRDS group [(33.132±10.132) ng/ml], the level of CCSP in cord blood of BPD group was (20.332 ± 8.066) ng/ml, which was significantly different(F=19.926, P<0.001).LSD test showed thatthe level of CCSP in control group and NRDS group was higher than that in BPD group(P<0.05).The CCSP level in cord blood of premature infants was positively correlated with gestational age and birth weight(r=0.533, 0.550, P<0.01).When the cutoff value of CCSP level was 31.560 ng/ml, the diagnostic efficiency was the highest, the Jordan index was 0.582, the sensitivity and specificity was 90.0% and 68.2%, respectively.And the area under ROC was 0.886 (95%CI: 0.814-0.957, P<0.01). Conclusion The low concentration of CCSP in cord blood of preterm infants may reflect early lung injury, which is related to the occurrence of BPD and can be used as a potential marker for the prediction of BPD.