血浆S100B、Tau、NSE在晚期早产儿胆红素神经损害中的预测价值

Predictive value of plasma S100B and Tau protein and NSE level in bilirubin induced-nerve damage in late preterm infants

目的:探讨血浆S100B、Tau、NSE在晚期早产儿胆红素神经损害中的预测价值。方法:选取2016年5月至2017年12月住院的晚期早产儿190例,根据不同胎龄(GA34W、GA35W、GA36W)分为观察组(伴高胆红素血症的晚期早产儿)100例及对照组(未伴高胆红素血症的晚期早产儿)90例、其中观察组依据血清总胆红素(total serum bilirubin, TSB)分为轻度升高、中度升高、重度升高三个亚组,分别于生后24 h抽取静脉血,采用酶联免疫吸附试验测定血浆S100B、Tau、NSE水平,采用重氮法测定TSB值,于生后7 d行新生儿行为神经评分(neonatal behavioral neurological assessment, NBNA)及脑干听觉诱发电位(brainstem auditory evoked potentials, BAEP)检测;观察组于生后10 d行头颅(magnetic resonance imaging, MRI)检查。结果:观察组血浆S100B、Tau、NSE水平升高、尤以中度、重度TSB组为著(P <0.05);与GA35W及GA36W比较,GA34W之血浆S100B、Tau、NSE水平升高(P <0.05);GA34W之NBNA评分低于其他两组(P <0.05);观察组(中度、重度TSB组)尤其是重度TSB组头颅MRI中T1高信号率显著高于轻度升高组及对照组(P <0.05)。结论:晚期早产儿早期检测血浆S100B、Tau、NSE水平联合NBNA、BAEP及头颅MRI有助于早期发现胆红素神经损害,对预防胆红素脑病具有指导性临床意义。

Objective:To investigate the predictive value of plasma S100B,Tau protein and NSE level in bilirubin induced-nerve damage in late preterm infants.Methods:We enrolled 190 late preterm infants admitted to NICU from May 2016 to December 2017.They were divided into an observation group with hyperbilirubinemia and a control group without hyperbilirubinemia.According to total serum bilirubin(TSB)level,the observation group was divided into three subgroups:mild,moderate and severe elevation.On the first day after birth,changes of venous plasma S100B,Tau protein and NSE levels were measured by ELISA,and TSB level were measured by DIAZO method.Neural development based on a neonatal behavioral neurological assessment(NBNA)score was detected 7 days after birth.Brainstem auditory evoked potential(BAEP)was measured,and brain magnetic resonance imaging(MRI)was performed 10 days after birth in the observation group.Results:Levels of NSE,S100B and Tau protein in the observation were higher than those in the control group,especially in the moderate and severe hyperbilirubinemic subgroups(P<0.05),and the level of plasma S100B,Tau and protein NSE in the observation group was higher than that in the control(P<0.05),and those protein levels of the gestational age(GA)34W group were higher than those in the GA35W and GA36W subgroups(P<0.05).The NBNA score of GA34W was significantly lower than that of the other two GA subgroups(P<0.05),and the hyperintensity on T1WI by MRI in the observation group(moderate and severe hyperbilirubinemic subgroups),especially in the severe hyperbilirubinemic group was significantly higher than that in the mild subgroup and the control(P<0.05).Conclusion:Early detection of plasma S100B,Tau protein and NSE level combined with NBNA,BAEP and MRI was helpful in the identification of bilirubin neuronal damage in late preterm infants,and was of important clinical significance in the prevention of bilirubin encephalopathy.