尿S100B蛋白和乳酸/肌酐在新生儿缺氧缺血性脑病早期诊断中的应用价值

Urinary S100B protein and lactate/creatinine ratio measurements: a tool for the early identification of neonatal hypoxic-ischemic encephalopathy

目的探讨尿S100B蛋白、尿乳酸/肌酐比值对新生儿缺氧缺血性脑病(HIE)早期诊断的应用价值。方法检测58例足月HIE患儿在生后第1天、第2天、第3天,尿S100B蛋白、尿乳酸/肌酐比值水平,并在生后7天内进行HIE临床分度,以同期25例足月正常新生儿对照组。结果HIE组出生后3天内尿S100B蛋白含量和出生后1天内尿乳酸/肌酐比值明显高于对照组(P<0.001);3天内尿S100B蛋白和1天内尿乳酸/肌酐比值之间及与HIE的临床分度呈正相关(P<0.001);当尿S100B蛋白水平在0.47μg/L,尿乳酸/肌酐比值在0.55时,单独检测第3天尿S100B蛋白敏感度、特异度分别为90.4%、91.9%;尿乳酸/肌酐比值预测HIE的敏感度和特异度以出生后第1天最高,分别为91.5%和90.3%;如检测第3天尿S100B蛋白的同时监测生后1天内尿乳酸/肌酐比值可显著提高HIE诊断的准确性,联合应用两项指标进行检测,诊断的敏感度和特异度分别为98.8%、97.4%,较两种方法单独应用敏感度和特异度均提高。结论对窒息患儿以临床表现为基础,同时监测出生后3天内尿S100B蛋白和尿乳酸/肌酐比值,对提高HIE的早期诊断和临床分度具有一定的应用价值。

Objective To investigate the value of urinary S100B protein and lactate/creatinine ratio determination in early identification of neonatal hypoxic-ischemic encephalopathy （HIE）. Methods The levels of urinary S100B protein and urinary lactate/creatinine ratio were detected in 58 full-term newborn infants with HIE on the first, second and third day after birth. The severity of clinical manifestations,including the degree of encephalopathy, was assessed within 7 days after birth. Twenty five normal neonates were enrolled into the control groups. Results （1） The urinary S100B level of HIE neonates was significantly higher in samples collected throughout the monitoring period than those of the normal control groups （all P 〈 O. 001 ）. The urinary lactate/creatinine ratio of the HIE neonates was also significantly higher than that of normal control groups within the first day （P 〈 O. 001 ）. （2） A significantly positive correlation was found between the level of urinary S100B protein within three days and the urinary lactate/creatinine ratio within the first day and between the level of urinary S100B protein within three days and clinical degree （P 〈0. 05）. （3） When S100B concentration was O. 47 μg,/L and urinary lactate/creatinine ratio was 0.55, the sensitivity and specificity of detecting the third day urinary S100B alone, were respectively 90.4% ,91.9%. Detecting it associated with the first day urinary lactate/creatinine ratio could increase the sensitivity and specificity （respectively 98. 8% and 97.4% ） for predicting development of HIE. Conclusion On the basis of clinical manifestations of asphyxic neonatals, detecting the level of urinary S100B within three days and the first day urinary lactate/ereatinine ratio may be of important value in early diagnosis and grading of HIE.