新生儿缺氧缺血性脑病血清UCH-L1水平变化及临床意义

Change and clinical significance of serum UCH-L1 level in neonates with hypoxic-ischemic encephalopathy

目的探讨新生儿缺氧缺血性脑病(HIE)血清泛素羧基末端水解酶-L1(UCH-L1)水平变化及其临床意义。方法选取2016年1月至2021年2月本院收治的109例HIE新生儿患儿为研究组,根据HIE分度标准将其分为轻度(n=56)、中度(n=36)和重度(n=17);另选取同期在本院分娩的106例健康新生儿为对照组。测定受试对象出生后6h内和72h的血清UCH-L1水平并评估新生儿神经行为测量(NBNA)评分,比较研究组与对照组、不同HIE分度组的UCH-L1水平和NBNA评分,采用Pearson相关法分析HIE患儿血清UCH-L1水平与NBNA评分的相关性。随访1年,比较预后良好组与预后不良组患儿出生后6h内UCH-L1水平及出生后6h内至72h的水平变化率,并采用受试者工作特征(ROC)曲线评估二者对新生儿HIE预后的预测价值。结果研究组出生后6h内、出生后72h的血清UCH-L1水平均高于对照组(t值分别为37.513和34.277,P<0.001),NBNA评分均低于对照组(t值分别为18.193和22.469,P<0.001)。出生后6h内、72h的血清UCH-L1水平在轻、中、重度HIE患儿中均依次升高(F值分别为85.183、90.446,P<0.001),NBNA评分均依次下降(F值分别为263.290、182.911,P<0.001)。HIE患儿各时间点UCH-L1水平与NBNA评分均显著负相关(r值分别为-0.865和-0.873,P<0.05)。随访1年,HIE患儿预后不良率为20.37%(22/108),预后良好组患儿出生后6h内UCH-L1水平低于预后不良组(t=5.652,P<0.001),出生后6h内至72h的UCH-L1水平变化率高于预后不良组(t=5.875,P<0.001)。ROC曲线显示,出生后6h内血清UCH-L1水平、出生后6h内至72h的UCH-L1变化率均对HIE患儿预后有一定的预测价值,灵敏度分别为72.73%和81.82%,特异度分别为76.74%和82.56%,曲线下面积分别为0.790和0.862。结论HIE新生儿血清UCH-L1水平异常升高,且随着病情加重升高愈加明显;与NBNA评分呈负相关关系,对HIE预后有一定的预测价值,可作为临床评估病情及预后的重要辅助指标。

Objective To investigate the change and clinical significance of serum ubiquitin C-terminal hydrolase L1(UCH-L1)in neonates with hypoxic-ischemic encephalopathy(HIE).Methods 109 neonates with HIE treated in our hospital from January 2016 to February 2021 were selected as the study group,who were divided into mild(n=56),moderate(n=36)and severe(n=17)according to the HIE grading standard.Another 106 healthy newborns delivered in our hospital at the same time were selected as the control group.The serum UCH-L1 levels and neonatal behavioral neurological assessment(NBNA)scores within 6 h and 72 h after birth of the all subjects were measured.The serum UCH-L1 levels and NBNA scores between the study group and the control group and among different HIE grade groups were compared.The correlation between serum UCH-L1 level and NBNA score in children with HIE was analyzed by Pearson correlation analysis.Followed up for one year,the UCH-L1 level within 6 h after birth and the change rate of the level from 6 h to 72 h after birth were compared between the good prognosis group and poor prognosis group,and the predictive values for evaluating the prognosis of neonatal HIE were analyzed by receiver operating characteristic(ROC)curve.Results The serum UCH-L1 levels within 6 h and 72 h after birth in the study group were higher than those in the control group(t value were 37.513 and 34.277,respectively,P<0.001),but the NBNA scores were lower than those in the control group(t value were 18.193 and 22.469,respectively,P<0.001).The levels of serum UCH-L1 within 6 h and 72 h after birth in children with mild,moderate and severe HIE increased in turn(F value were 85.183 and 90.446,respectively,P<0.001),while the NBNA scores decreased in turn(F value were 263.290 and 182.911,respectively,P<0.001).The levels of serum UCH-L1 at each time point in children with HIE were significantly negatively correlated with the NBNA score(r values were-0.865 and-0.873,respectively,P<0.05).After 1 year follow-up,the poor prognosis rate of children with HIE was 20.37%(22/108).The level of serum UCH-L1 within 6 h after birth in the poor prognosis group was higher than that in the good prognosis group(t=5.652,P<0.001),but the change rate of UCH-L1 level from 6 h to 72 h after birth in the poor prognosis group was lower than that in the good prognosis group(t=5.875,P<0.001).The ROC curve showed that the serum UCH-L1 level within 6 h after birth and the change rate of UCH-L1 from 6 h to 72 h after birth had certain predictive values for the prognosis of HIE children.The sensitivity was 72.73%and 81.82%,respectively.The specificity was 76.74%and 82.56%,respectively,and the area under the curve was 0.790 and 0.862,respectively.Conclusion The serum UCH-L1 level of neonates with HIE increased abnormally,and the increase becomes more obvious with the aggravation of the disease.It has a negative correlation with NBNA score,and has a certain predictive value for the prognosis of HIE.It can be used as an important auxiliary index for clinical evaluation of the disease and prognosis.