高胆红素血症新生儿脑脊液神经元特异性烯醇化酶和胆红素水平变化的意义

Significance of Cerebrospinal Fluid Neuron Specific Enolase and Bilirubin in Neonates with Hyperbilirubinemia

目的了解足月新生儿胆红素脑损伤时脑脊液（CSF）神经元特异性烯醇化酶（NSE）是否增高，探讨CSF中NSE水平（CSF-NSE）与NBNA评分、CSF中胆红素（CSF-BIL）及血清间接胆红素水平（s-UCB）等的相关性。方法随机选择日龄3～7d的足月新生儿黄 疸39例，根据NBNA评分和核黄疸痉挛期的诊断，分为NBNA评分正常组（17例）、NBNA低分组（15例）和核黄疸痉挛期组（7例）；测定CSF-NSE、CSF-BIL和s—UCB水平。结果3组CSF-NSE、CSF-BIL和s-UCB均有显著性差异（P均〈0．01）；两两比较CSF-NSE均有显著性差异（P均〈0．05）；NBNA评分正常组CSF-BIL与NBNA低分组差异无显著性意义（P=0．259）；NBNA评分正常组s-UCB与NBNA低分组差异无显著性意义（P=0．279）；CSF-NSE和NBNA评分、CSF-NSE、s-UCB相关（r=-0．879，0519，0．661P均〈0．01）。发生胆红素脑损伤时CSF-NSE平均值的95％可信区间〉14．93μg／L。结论测定CSF-NSE对新生儿高胆红索血症脑损伤诊断具有较重要价值；足月高胆红素血症新生儿以NBNA评分可推测CSF-NSE水平；NBNA低分时，可能存在胆红素脑损伤。

Objective To detect neuron specific enolase （NSE） level in cerebrospinal fluid （CSF） from term infants with hyperbilirubinemia in order to study the bilirubin damage to brain, and study correlationes between CSF- NSE level and neonatal behavioral neurological assessment （NBNA） .score, bilirubin concentration in CSF （CSF- BIL） and serum unconjugated bilirub （s- UCB）. Methods From August 2002 to August 2005, 39 term infants with hyperbilirubinemia, aged 3 - 7 days, were divided into 3 groups： normal NBNA group （ n = 17）, abnormal NBNA group （ n = 15） and kemicterus （convulsion phase） group （ n = 7） according to NBNA .scores and clinical diagnosis of kemicterus. The concentrations of CSF - NSE, CSF - BIL and s - UCB were determined respectively. Results The CSF- NSE, CSF- BIL and s - UCB levels in 3 groups had significant difference （all P〈0.01） ; the value of every two groups of multiple comparisons of CSF- NSE levels had significant difference （all P 〈 0.05） ; for multiple comparisons of CSF- BIL and s- UCB levels, there were no significant differences between normal NBNA group and abnormal NBN A group （ P = 0. 259,0. 279） ; there were correlations between CSF- NSE and NBNA score, CSF- NSE and CSF- BIL, CSF- NSE and s- UCB （ r = - 0. 879,0. 519,0. 661 all P〈0.01）. The 95% confidence interval of NSE was more than 14.93 μg/L. Conclusions In term infants with hyperbilirubinemia, CSF - NSE is a fine biochemical marker of bilirubin damage to brain. There is a possibility that CSF - BIL in term infant with hyperbilirubinemia has less important value than NBNA on estimating bilirubin - induced brain damage; and CSF - NSE and NBNA score show strong significantly negative correlation, CSF- NSE level can be worked out according to NBNA score. Term infants with hyperbilirubinemia, who get abnormal NBNA score, may suffer form bilirubininduced brain damage, and require vigilance and intervention.