目的 探讨外周血单核细胞髓样分化因子88(My D88)与Toll样受体4(TLR4)在早产儿窒息后多器官功能障碍综合征(MODS)中的表达,为早产儿窒息后MODS的早期诊断及预后评估提供新思路。方法 连续性纳入2019年1月-2020年12月唐山市妇幼保健院新生儿科收治的115例窒息早产儿进行前瞻性研究,按照1 min Apgar评分将窒息早产儿分为轻度窒息组(n=70)与重度窒息组(n=45),以同期的50例健康早产儿作为对照组。比较3组早产儿中MODS发生率、MODS病死率及单器官损害发生率,外周血单核细胞My D88 mRNA及蛋白与TLR4 mRNA及蛋白的表达水平。结果 重度窒息组、轻度窒息组与对照组的MODS发生率分别为73.33%、31.43%、6.00%,MODS病死率分别为24.44%、5.71%、0,3组间比较差异有统计学意义(χ²=47.845、16.978,P＜0.001);重度窒息组与轻度窒息组的单器官损害发生率明显高于对照组(P＜0.05),重度窒息组明显高于轻度窒息组(P＜0.05);重度窒息组与轻度窒息组的My D88 mRNA及蛋白与TLR4 mRNA及蛋白均明显高于对照组,且重度窒息组明显高于轻度窒息组(F=4.251、4.804、4.772、4.690,P＜0.001)。结论 早产儿窒息后MODS发生率、外周血单核细胞My D88与TLR4表达水平均明显增高,My D88与TLR4有望成为早产儿窒息后MODS的早期诊断及预后评估指标。

Objective To discuss the expression of peripheral blood mononuclear cells myeloid differentiation factor 88(My D88) and Toll-like receptor 4(TLR4) in multiple organ dysfunction syndrome(MODS) after asphyxia in premature infants, in order to provide a new idea for the early diagnosis and prognosis evaluation of MODS after asphyxia in premature infants. Methods A prospective study was conducted on 115 cases of asphyxiated premature infants in Neonatology Department of Tangshan Maternal & Child Health Care Hospital from January 2019 to December 2020.According to 1 min Apgar scores, the asphyxiated premature infants were divided into mild asphyxia group (n=70) and severe asphyxia group (n=45).Meanwhile, 50 cases of healthy preterm infants were selected as the control group.The prevalence of MODS, the mortality of MODS and the incidence of single organ damage were compared among the three groups.The expression levels of My D88 mRNA and protein, TLR4 mRNA and protein were compared among three groups. Results The incidence rates of MODS in severe asphyxia group, mild asphyxia group and control group were 73.33%, 31.43% and 6.00%, respectively, and the mortality rates of MODS were 24.44%, 5.71% and 0, respectively.There were statistically significant differences in the incidence rate of MODS and the mortality rate of MODS among the three groups (χ²=47.845, 16.978, P<0.001).The incidence of single organ damage in severe asphyxia group and mild asphyxia group were significantly higher than that in control group (P<0.05), and the incidence of single organ damage in severe asphyxia group was significantly higher than that in mild asphyxia group (P<0.05).The expression levels of My D88 mRNA and protein, TLR4 mRNA and protein in severe asphyxia group and mild asphyxia group were significantly higher than those in control group, which were also significantly higher in severe asphyxia group than in mild asphyxia group (F=4.251, 4.804, 4.772, 4.690, P<0.001). Conclusions The incidence of MODS and the expression levels of peripheral blood mononuclear cells My D88 and TLR4 are significantly increased in asphyxiated premature infants.My D88 and TLR4 are expected to be indicators for early diagnosis and prognosis evaluation of MODS after asphyxia in premature infants.