尿激活素A对新生儿缺氧缺血性脑病诊断及病情判断的价值

The value of urinary activin A on diagnosis and illness situation of neonatal hypoxic-ischemic encephalopathy

目的观察窒息新生儿尿激活素A含量的变化，探讨尿激活素A与新生儿缺氧缺血性脑病（hypoxic—ischemic encephalopathy；HIE）的关系，为HIE的诊断及病情判断提供重要依据。方法选择50例窒息足月新生儿为观察组，随机选择48例同期出生正常足月新生儿为正常对照组。生后7d内根据新生儿缺氧缺血性脑病诊断标准和临床分度，将50例窒息新生儿分成轻度HIE组30例、中重度HIE组20例。采用ELISA方法检测两组新生儿生后不同时间（2、12、24、48、72h）尿激活素A的含量。结果中重度HIE组尿激活素A含量显著高于正常对照组（P〈0．01）和轻度HIE组（P〈0．01）；正常对照组和轻度HIE组尿激活素A含量无显著性差异（P〉0．05）。以尿激活素A含量〉70ng／L为临界值判断中重度HIE发生，2h尿激活素A含量的敏感度为82％、特异度为99％；12—72h尿激活素A含量的敏感度为100％、特异度为98％。结论尿激活素A含量与HIE病情程度呈正相关，对判断中重度HIE的发生有高度的敏感性及特异性，为诊断中重度HIE提供重要依据。

Objective To explore the relationship between urinary activin A and neonatal hypoxic-is- chemic encepbalopathy（HIE） by observing the change of urinary activin A in neonates with asphyxia, Provides the important basis for the HIE diagnosis and the condition judgment. Methods 50 cases of neonatal asphyxia term were the observation group ,48 cases of normal full-term newborns born in the same period were stochasti- cally the normal control group. Within 7 days after birth, 50 cases of neonatal asphyxia were divided into the group of 30 patients with mild HIE and the group of 20 patients with moderate and severe HIE, according to diagnostic criteria and clinical grading of neonatal hypoxic-ischemic encephalopathy, the levels of urinary activin A in two groups after birth different time（2, 12, 24, 48, 72 h） were determined by using ELISA method.Results The levels of urinary activin A in moderate and severe HIE group was significantly higher than the nor- mal control group（ P 〈 0. 01 ） and mild HIE group （ P 〈 0. 01 ） ; The levels of urinary activin A in the normal con- trol group and mild HIE group showed no significant differences（ P 〉 0. 05 ）. Urinary activin A levels 〉 70 ng/L for the critical value to determine the occurrence of moderate and severe HIE, the sensitivity and specificity of 2 h urinary activin A levels were separately 82% and 99% ;the sensitivity and specificity of 12-72 h urinary activin A levels were separately 100% and 98%. Conclusion The correlation between the levels of urinary activin A and the severity of HIE was positive, the levels of urinary activin A had a high degree of sensitivity and specifici- ty for determine the incidence of moderate and severe HIE, it provided an important basis for diagnosis of moderate and severe HIE.