促红细胞生成素和神经元特异性烯醇化酶在热性惊厥中的变化及意义

The Change and Significance of Erythropoietin and Neuron-specific Enolase Levels in Serum and Cerebrospinal Fluid of Children with Febrile Convulsion

目的观察热性惊厥(FC)患儿血清、脑脊液促红细胞生成素(EPO)和神经元特异性烯醇化酶(NSE)的浓度变化情况,探讨他们与FC后脑损伤的可能作用。方法本研究纳入52例热性惊厥患儿(其中单纯型24例,复杂型28例)和28例对急性上呼吸道感染患儿(对照组)均在发病24h内检测血清和脑脊液EPO、NSE浓度,进行统计分析。结果复杂型FC组血清、脑脊液EPO浓度分别为3.63±0.92mU/ml、13.46±2.82mU/ml,NSE分别为9.30±1.83ng/ml、33.17±11.17ng/ml;单纯型血清、脑脊液EPO浓度分别为3.11±0.56mU/ml、10.26±2.67mU/ml,NSE分别为8.32±1.90ng/ml、25.25±8.86ng/ml,对照组血清、脑脊液EPO和NSE浓度分别为2.58±0.73mU/ml、8.25±2.40mU/ml和6.64±2.01ng/ml和17.97±5.28ng/ml,FC组发作后24h内血清和脑脊液EPO、NSE浓度均高于对照组(P<0.05);复杂型患儿血清和脑脊液EPO和血清NSE浓度也高于单纯型(P<0.05)。FC组脑脊液EPO浓度与血清EPO浓度存在正相关(r=0.562,P=0.000),脑脊液NSE浓度也与血清NSE浓度正相关(r=0.479,P=0.000);血清EPO与脑脊液、血清NSE分别存在相关(r=0.354,P=0.010;r=0.344,P=0.013),脑脊液EPO浓度与血清NSE有正相关(r=0.500,P=0.012)。结论FC发作后早期即可引起脑脊液和血清EPO、NSE浓度的显著升高,且存在显著正相关关系,提示惊厥后脑损伤程度越严重,脑脊液EPO升高也越显著,脑脊液EPO、NSE均可能是早期预测FC后脑损伤的程度的指标之一,推测EPO可能参与了早期FC后脑损伤的发生发展机制,并提示惊厥后血脑脊液屏障的通透性改变起了重要的作用。

Objective To observe the changes of erythropoietin （EPO） and Neuron - specific Enolase （NSE） in serum and cerebrospinal fluid （CSF） in Children with Febrile Convulsion（FC） , and to study the relationship between EPO levels, NSE levels and brain injury. Methods Serum EPO and NSE levels were measured by chemiluminescence immunoassay（CLIA） and electrochemiluminescence assay respectively, in fifty - two Children with FC （ FC group ： twenty - four simple FC, twenty - eight complex FC ） and twenty - eight Children with upper respiratory infections （ Control group） within twenty - four hours after onset of their illness; CSF EPO and NSE levels were measured at the same time. Results Compared with the control group, EPO and NSE levels of FC group in serum and CSF increased significantly （ P 〈 0. 05 ） within twenty - four hours after onset of their illness ; and EPO level in serum and CSF and NSE level in serum of complexity FC group are also increased significantly than ones of simplicity respectively（ P 〈 0. 05 ）. There was a significant linear and positive correlation between serum and CSF EPO levels in FC group（ r = 0. 562 ,P 〈 0. 000） , and the same correlation to NSE levels in the group（r = 0. 479, P 〈 0. 000）. It was also observed that serum EPO levels correlated with serum and CSF NSE levels respectively （r =0. 354,P =0. 010; r =0. 344,P =0. 013） , and CSF EPO level shows significant correlation with serum NSE levels （r =0. 500,P = 0. 012）. Conclusion The increased EPO and NSE levels in serum and CSF may be a sensitive marker of brain injures of children after onset of FC, and increasing level of them is correlated with subgroup of FC. Therefore, CSF EPO level can possibly reflect the severity of brain injure after FC. It shows a suggestion that Epo participates the brain injure mechanism after FC. Besides, impaired blood brain barrier（BBB） might account for the increased CSF EPO levels.