通过脐动脉血乳酸及神经特异性烯醇化酶水平早期诊断新生儿缺氧缺血性脑损伤

Umbilical artery lactate and neuron-specific enolase levels for early diagnosis of neonatal hypoxic-ischemic brain damage

目的通过测定新生儿脐动脉血中的乳酸及神经特异性烯醇化酶(Neuron-specificenolase,NSE)水平早期诊断新生儿缺氧缺血性脑损伤。方法50例产前无胎儿窘迫征象,出生后1分钟minApgar评分≥9分的新生儿为对照组;25例诊断为新生儿缺氧缺血性脑病的新生儿为病例组。所有新生儿出生后立即收集脐动脉血,检测乳酸及NSE值。结果病例组脐动脉血乳酸水平为4.55±1.07mmol/L、NSE水平为14.01±4.35μg/L。对照组脐动脉血乳酸水平为2.37±0.29mmol/L、NSE水平为7.61±2.14μg/L。病例组均明显高于对照组(P<0.01);且脐动脉血NSE与乳酸水平呈显著正相关(r=0.832,P<0.01)。新生儿发生HIE的孕妇80%在孕期存在严重合并症或并发症,仅有20%是由于产时急性缺氧所致。结论测定脐动脉血乳酸及NSE水平是一种准确、可靠的早期诊断新生儿缺氧缺血性脑损伤及其严重程度的指标。新生儿缺氧缺血性脑损伤多是产前并发症引起较长时间的缺氧缺血所致,也有少部分是产时急性缺氧引起。

Objective:To diagnose early neonatal hypoxic-ischemic brain damage by measuring umbilical artery lactate and NSE levels.Methods:There were fifty neonates without the symptoms of fetal distress and Apgar score≥9 in the control group.There were twenty five neonates with HIE in the study group.All neonates were measured for umbilical artery lactate and NSE levels at delivery.Results:The umbilical artery NSE(14.01±4.35μg/L) and lactate levels (4.55±1.07mmol/L) in HIE group was significantly higher than those (lactate 2.37±0.29mmol/L,NSE7.61±2.14μg/L) in the control group ( P <0.01).There were a positive correlation between NSE and lactate levels in umbilical artery( r =0.832, P <0.01).In HIE group,eighty percent of neonates' mothers suffered complications during pregnancy and only twenty percent of neonates suffered acute distress in delivery.Conclusion:Measuring umbilical artery NSE and lactate levels is an efficient and accurate technique for early diagnosis of neonatal hypoxic-ischemic brain damage and evaluation of the severity.Mostly neonatal hypoxic-ischemic brain damages are due to the long time hypoxia-ischemia induced by complications in antepartum and the few are due to acute distress in delivery.