脑白质损伤早产儿血清髓鞘碱性蛋白和S100B蛋白的变化及与预后的关系

The reliability of serum myelin basic protein and S100B protein in predicting outcome of premature infants with periventricular leukomalacia

目的探讨脑白质损伤（periventricular leukomalacia,PVL）患儿血清髓鞘碱性蛋白（ myelin basic protein, MBP）及S100B蛋白（S100B protein，S100B）的动态变化及其与患儿预后的关系。方法对2007年11月至2008年7月我院住院的78例PVL早产儿（PVL组）和43例正常早产儿（正常对照组），分别在其生后第1、3、7、14天测定血清中MBP及S100B含量。30例正常早产儿及69例PVL患儿出院后每3个月随访1次，直至纠正胎龄至1岁，用Gesell发育量表测定其智力以及运动发育情况。结果（1）PVL组患儿血清MBP于生后第1天升高[（7．61±1．78）μg／L]、第3天达峰值[（14．53±3．12）μg／L]，后随病情好转，逐渐降低；与正常对照组比较，PVL组患儿在生后第1、3、7、14天血清MBP水平均明显高于正常对照组（P〈0．05）。（2）PVL组患儿血清S100B水平在生后第1、3、7天明显升高[（3．82±0．68），（4．41±0．91），（5．78±1．54）μg/L]，第7天达峰值，与正常对照组比较，差异有统计学意义（P〈0．05）；至生后第14天时，S100B明显降低，两组比较已无明显差异（P〉0．05）。（3）PVL组患儿生后第7天血清S100B、MBP持续升高者，随访至1岁时其发育商比生后第7天血清S100B及MBP明显下降者落后；也明显落后于正常早产儿（P〈0．05）。结论PVL患儿生后血清MBP及S100B水平与病情严重程度相关。如患儿血清MBP及S100B持续升高超过7d，则发育商明显落后，预后不良。

Objective To investigate the changes of serum myelin basic protein （MBP） and S100B Protein （S100B） in premature infants with periventricular leukomalacia （PVL） and their outcomes. Methods Seventy-eight premature infants with PVL （ PVL group） and 43 normal infants （ control group） who were hospitalized in our hospital from Nov 2007 to Jul 2008 were enrolled in the study. The infants were sampled for MBP and S100B levels on 1st ,3rd ,7th and 14th d after birth. Thirty normal infants and 69 infants with PVL were followed up every three months as they discharged until they were one year corrected age and their development quotients（DQ） were measured using Gesell development schedules. Results （ 1 ） The serum MBP levels increased on day 1 [ （7.61 ± 1.78） μg/L] ,peak on day 3 E （14. 53 ± 3.12） μg/L], and then decreased. The serum MBP levels in infants with PVL group were significantly higher than those of control group at 1st ,3rd, 7th and 14th d after birth （ P 〈 0. 05 ）. （2） The serum S100B levels increased on day 1, day 3 and day 7 [ （3.82 ±0. 68）, （4.41 ±0. 91 ）, （5.78±1.54） μg/L] ,peaked on day 7 ,and then decreased. The S100B levels of infants in PVL group were significantly higher than those of control group at 1st ,3td and 7th d after birth （P 〈 0. 05 ） ;and decreased on day 14 （P 〉 0.05 ）. （3） Infants whose MBP and S100B levels increased at 7th day after birth had significantly decreased DQ than those of normal infants （ P 〈 0. 05 ）. Conclusion The serum MBP and S100B levels in infants with PVL are correlated with the severity of central nervous system injury. If the serum S100B and MBP levels of PVL infants continues to rise more than 7 d,the DQ are lower, and the outcomes are poor.