Abstract: Objective To observe the changes of Toll- like receptor 4 ( TLR-4 ) and tumor necrosis factor -α (TNF-α) levels in peripheral blood,and CDCC results of six months old,explore the relationship between the levels of TLR-4,TNF-α and preterm labor and its significance in evaluation of preterm brain injury,provide ideas for early intervention to the prevention of premature and prognosis of brain injury. Methods A total of 120 newborn cases were selected and divided into full-term infants and premature infant group according to gestational age;Preterm groups was divided into:idiopathic preterm group and premature rupture of fetal membranes group according to delivery reason (PROM).The serum levels of TLR-4,TNF-α in peripheral venous blood taken on 30 minutes after birth in newborns were detected by enzyme-linked immunosorbent assay (ELISA).And all the subjects had CDCC when they were six months old. Results The serum levels of TLR-4 and TNF-α in the two premature infant groups were higher compared with those of control group (P<0.05),The levels of TLR-4 and TNF-α were positively correlated in PROM preterm group and idiopathic preterm premature group.The serum level of TNF-α was significantly higher in the neonates with abnormal CDCC than that of with normal CDCC (P<0.05) in preterm group after birth. Conclusions The levels of TLR-4 and TNF-α of two preterm groups are higher than those in full-term infants,which indicates significantly that cytokines are closely related to the onset of premature rupture of membranes and idiopathic preterm;The levels of TLR-4 and TNF-α are positively correlated,which suggests that TLR-4 may be as an upstream factor to activate TNF-α then promote preterm birth for premature.The level of TNF-α in serum after birth in preterm could be used as an early marker of brain injury.

Key words: Toll-like receptor 4, tumor necrosis factor-α, premature, premature rupture of membrane, white matter damage

摘要： 目的 观察早产儿出生时外周血Toll样受体4(Toll- like receptor 4,TLR-4)、肿瘤坏死因子α(tumor necrosis factor -α,TNF-α)的水平及校正胎龄6个月龄时智力发育测试(CDCC)结果,探讨其在早产发生机制中的作用及其与早产儿脑损伤预后的关系,为预防早产及对脑损伤早期干预提供依据。方法 新生儿120例,分为:足月儿40例、胎膜早破早产儿40例和特发性早产儿40例。采用ELISA检测新生儿外周静脉血中TLR-4、TNF-α的水平,校正胎龄达6个月时做婴幼儿CDCC。结果 两组早产儿血清TLR-4、TNF-α水平均高于足月新生儿组,差异有统计学意义(P＜0.05);两组早产儿血清TLR-4、TNF-α均呈正相关,差异有统计学意义(P＜0.01)。随访CDCC异常者出生时外周血清中TLR-4、TNF-α水平明显高于正常者水平,二者比较差异有统计学意义(P＜0.01)。结论 早产儿血清TLR-4、TNF-α水平均高于足月新生儿,提示细胞因子TLR-4、TNF-α的激活与胎膜早破早产、特发性早产分娩发动机制密切相关;TLR-4、TNF-α呈正相关性,提示TLR-4可能作为上游因子通过激活细胞因子TNF-α而发挥促进早产分娩的作用。早产儿出生时外周血中TLR-4、TNF-α水平可作为早期判断脑损伤预后的指标。

关键词: Toll样受体4, 肿瘤坏死因子α, 早产, 胎膜早破, 早产儿脑损伤