血清神经元特异性烯醇化酶及S100B蛋白在新生儿胆红素脑损伤的变化及意义

Changes of serum neuron specificity enolase and S100B protein in newborn with hyperbilirubinaemia

目的通过对患高胆红素血症的足月新生儿检测血清神经元特异性烯醇化酶(NSE)及S100B蛋白浓度,探讨血清NSE及S100B蛋白在诊断新生儿胆红素脑损伤的临床意义。方法随机选择日龄2～28天的患高胆红素血症的新生儿115例为观察组,正常新生儿24例为对照组。利用酶联免疫吸附测定法检测血清中NSE及S100B蛋白浓度,同时采用重氮法测定血清总胆红素(TSB)。同期检测观察组新生儿脑干听觉诱发电位(BAEP),受试者工作特征曲线(ROCC)分析NSE、S100B蛋白、TSB与BAEP的相关性。结果 1.观察组TSB、NSE及S100B蛋白(分别为301.4±65.9μmol/L、33.7±25.2ng/ml、2782.9±1585.5ng/L)明显高于对照组(分别为37.4±7.9μmol/L、9.9±4.4ng/m、1143.5±377.3ng/L),P=0.000;2.BAEP异常组血清TSB(295.1±38.0μmol/L)与正常组(307.0±61.2μoml/L)比较无显著差异性(P=0.527);3.BAEP异常组血清NSE(64.4±33.6ng/ml)及S100B蛋白(4552.9±1958.1ng/L)与正常组(分别为26.1±21.7ng/ml、2194.2±1336.2 ng/L)比较有显著差异性(P=0.000);4.根据TSB来判断BEAP的异常并没有显著意义(P=0.793)。NSE、S100B蛋白的最佳工作点分别为30.6ng/ml、2357.4μg/L,预测黄疸新生儿听力损害的敏感性均为90%,特异性分别为75.6%、66.7%。血清NSE及S100B蛋白具有较高的预测敏感性,NSE的特异性略优于S100B蛋白,两者的敏感性及特异性均高于TSB,差异有统计学意义(P均为0.001)。结论患高胆红素血症的新生儿,测定血清中NSE及S100B蛋白的浓度对诊断新生胆红素脑损伤具有较重要的价值;是临床上判断胆红素脑损伤的敏感指标。

Objective： To detect the serum neuron specificity enolase（NSE） and S100B protein from term infants with hyperbilirubinaemia in order to study theClinical significance of serum NSE and S100B protein.Methods： Total serum bilirubin,NSE and S100B protein were measured in 115 jaundice infants were enrolled.There were 24 health cases in control group.Brainterm auditory-evoked response was performed in case group on admission.Results： 1.There were significant differences of TSB、NSE and S100B protein concentration between control（301.4±65.9μmol/L,33.7±25.2ng/ml,2782.9±1585.5ng/L）and case group（37.4±7.9μmol/L,9.9±4.4ng/ml,1143.5±377.3ng/L）,P=0.000.2.There wasn＇t significant difference of TSB between BAEP abnormal group（295.1±38.0μmol/L）and normal group（307.0±61.2μoml/L）,P=0.527.3.There were significant differences of NSE and S100B protein between BAEP abnormal group（64.4±33.6ng/ml,4552.9±1958.1ng/L）and normal group（26.1±21.7ng/ml,2194.2±1336.2 ng/L）,P=0.000.4.The area under curve（AUC） of NSE and S100B receiver operating characteristic curves（ROCC） were 0.844 and 0.831,significantly larger than that of TSB（0.473）.Compared with TSB,NSE had its best diagnostic value with 90% sensitivity and 75.6% specificity at the level of 30.6ng/ml（P=0.001）,S100B had its best diagnostic value with 90% sensitivity and 66.7% specificity at the level of 2357.4μg/L（P=0.001）.Conclusions： Serum NSE and S100B protein have more value on prognosticating for bilirubin encephalopathy than TSB.