新生儿缺氧缺血性脑病检测心肌酶的研究

A study on relation between serum myocardial enzymological detection and HIE of the newborn

目的 研究血清心肌酶学检测与新生儿缺氧缺血性脑病的关系及相关性.方法 选取渭南市第一医院儿科就诊的新生儿缺氧缺血性脑病患者97例,均于生后12～24h内,分别测定血清谷草转氨酶、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶的活性及尿酸含量,并对新生儿神经行为评分,将新生儿分为缺氧缺血性脑病轻度组、中度组和重度组.结果 心肌酶谱活性的变化与新生儿缺氧缺血性脑病的发生及程度呈正相关,中度组和重度组患儿血清尿酸、谷草转氨酶、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶及新生儿神经行为评分与轻度组患儿相比具有显著性差异（P〈0.01或P〈0.05）;简单相关分析表明：新生儿缺氧缺血性脑病程度与血清尿酸、谷草转氨酶、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶及α-羟丁酸脱氢酶呈正相关（r分别为0.626、0.592、0.614、0.615、0.668和0.775,均P〈0.05）,其中与α-羟丁酸脱氢酶相关性最强;与新生儿神经行为评分呈负相关（r=-0.757;P〈0.05）.结论 新生儿缺氧缺血性脑病患儿心肌酶增高,其中α-羟丁酸脱氢酶和新生儿神经行为评分对判断缺氧程度、判断病情及指导治疗有更重要的临床意义.

Objective To study relationship between serum myocardial enzymological detection and hypoxic-ischemic encephalopathy （HIE） of the newborn. Methods 97 neonates with HIE admitted to Department of Pediatrics, The First Weinan Municipal Hospital were selected in the study. Within 12 - 24 hours after birth, activities and serum levels of myocardial enzyme spectrum such as glutamicoxaloacetic transaminase （GOT）, creatinkinase （CK）, isoenzymes of CK, lactate dehydrogenase （LDH）, hydroxybutyrate dehydrogenase （HBDH） and uric acid （UA） of all neonates were detected. Meanwhile, all neonates received neonatal behaviral neurological assessment （NBNA） and were divided into mild HIE group, moderate HIE group and sever HIE group according to results of NBNA. Results The changes in serum myocardial enzymology of the neonates were positively related to development and severity of HIE of the neonates. The serum levels of GOT, CK, isoenzymes of CK, LDH, α-HBDH, UA of the neonates in the moderate HIE group and the severe HIE group were significantly higher than those neonates in the mild HIE group and their scores in NBNA were significantly lower than those neonates in the mild HIE group（ all P 〈0.01 or 0.05）. The simple correlation analysis showed that severity of HIE of the neonates was positively correlated to serum levels of UA, GOT, CK, isoenzymes of CK, LDH, α-HBDH （r = 0.626, 0.592, 0.614, 0. 615, 0.668 and 0. 775 respectively, all P 〈 0.05 ）, of which, the correlation of HIE of the neonates with α-HBDH was the strongest, and was negatively correlated to scores in NBNA of the neonates （ r = - 0. 757, P 〈 0.05 ） ）. Conclusion The serum levels of myocardial enzymes of the neonates with HIE are higher,of which, the serum level of α-HBDH and scores in NBNA are more important significances for judging severity of brain hypoxia, severity of the disease and guiding to the treatment.