血清神经元特异性烯醇化酶及S100B蛋白水平在早期评价窒息新生儿脑损伤中的意义

Significance of serum neuron-specific enolase and S100B protein in the early evaluation of brain damage of newborns with perinatal asphyxia

目的:探讨新生儿窒息后血清S100B蛋白和神经元特异性烯醇化酶(NSE)水平动态变化对诊断新生儿窒息和判断窒息后脑损伤的价值。方法:30例临床诊断为窒息的新生儿,分别于生后12h、72h、7d取外周静脉血血清-70℃低温保存。用酶联免疫吸附(ELISA)方法分别检测S100B、NSE的血清浓度。以20例正常新生儿为对照组。结果:轻、重度窒息新生儿生后12h血清NSE、S100B水平与对照组比较,差异有统计学意义(P<0.01)。轻、重度窒息新生儿组间血清NSE水平比较,差异无统计学意义(P>0.05);血清S100B水平比较,差异有统计学意义(P<0.01)。窒息新生儿组内各时间点(12h、72h、7d)血清NSE水平比较,只有12h和72h两两比较差异有统计学意义(P<0.01);S100B蛋白水平两两比较,差异均有统计学意义(P<0.01)。窒息新生儿30例中有14例(重度窒息5例,轻度窒息9例)生后5～7d头颅CT示不同程度的缺氧缺血性改变。结论:S100B蛋白、NSE在窒息新生儿血清中显著升高。NSE、S100B蛋白血清浓度升高持续时间越长,预示发生新生儿窒息后颅脑损伤的可能性越大。

Objective： To investigate the value of serum S100B protein and NSE levels in the diagnosis of neonatal as- phyxia and in the identification of brain damage flowing neonatal asphyxia. Methods： 30 asphyxiated full-term newborn infants were selected, and peripheral vein blood 12 h, 72 h and 7 d after birth was collected. The serum was conserved - 70℃. Serum NSE and S100B protein were measured by ELISA. The control group had 20 cases of normal newborn infants. Results： The results of NSE and S100B showed that there were significant differences between control group and mild asphyxiated group as well as severe asphyxiated group 12 h after birth （P〈0.01）. There was a significant difference of S100B but not NSE between mild asphyxiated group and severe asphyxiated group （P〈0.01 and P〉0.05）. There were significant differences between 12 h and 72 h in mild asphyxiated group and severe asphyxiated group （P〈0.01）; but there were significant differences in S100B of 12 h, 72 h and 7 d in mild asphyxiated group and severe asphyxiated group （P〈0.01）. Among the 30 newborns of asphyxia, 14 cases, including 5 cases of severe asphyxiated newborns and 9 cases of mild asphyxiated newborns, showed hypoxic-ischemic encephalopathy mildly or severely through cranial CT scans. Conclusion： Neuron specific-enolase and S100B protein are considered to be neurobiochemical markers for brain damage. They are also increased in the serum of newborns with asphyxia. The long time of higher NSE and S100B protein levels predicts a complicate severe brain damage and a bad outcome.