血清和尿S-100B蛋白对新生儿缺氧缺血性脑病预后的评估价值

Predictive value of serum and urine S-100B protein for the outcome of neonatal hypoxic-ischemic encephalopathy

【目的】调查缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)新生儿生后不同时间点血清和尿S-100B蛋白的变化,探讨其判断病情及其预后的临床价值。【方法】采用双抗体夹心酶联免疫吸附法(ELISA)检测48例HIE新生儿和25例正常对照儿生后1、3d和7d血清和尿S-100B蛋白,并对HIE患儿在1岁时做了随访观察。【结果】HIE组生后1、3d和7d血清和尿S-100B蛋白均较正常对照组明显增高(P<0.05或<0.01),其增高程度与病情一致,即S-100B蛋白越高,病情越重;预后异常组生后1d和3d血S-100B和生后3d和7d尿S-100B蛋白明显高于预后正常组(P<0.05或<0.01)。以血S-100B>5μg/L和尿S-100B>3μg/L作为判断HIE不良预后的界值,生后1d和3d血S-100B>5μg/L判断预后的准确性分别为88.1%和77.3%;生后3d和7d尿S-100B>3μg/L判断预后的准确性分别为90.5%和85.7%。血和尿S-100B蛋白对判断HIE预后差异无统计学意义。【结论】HIE新生儿生后血清和尿S-100B蛋白升高与病情及预后密切相关,S-100B蛋白对判断新生儿HIE预后具有重要的临床价值。

[Objective] To explore the clinical significance of serum and urine S-100B at different time points after birth in evaluating the severity and predicting the prognosis of neonatal hypoxic-isehemic encephalopathy （HIE）. [Method] Serum and urine S-100B were measured in the 48 HIE neonates and 25 control neonates at day 1,3 and 7 after birth by ELISA and followed up at age of 1 year for HIE infants. [Results] The levels of serum and urine S-100B at day 1,3 and 7 after birth in the HIE group were significantly higher than in control group （P〈0.01 or d0.05） and there was a close positive relationship between the level of S-100B protein and severity of HIE. The levels of serum S-100B at day 1 and 3 and urine S-100B at day 3 and 7 after birth in the abnormal group of outcome were significantly higher than normal group of outcome at age of 1 year （P〈0.05 or 〈0.01）. At a cut off 〉5 μg/L of serum S-I00B protein and 〉3 μg/L of urine S-100B in there was a relatively good predictive value of S-100B for neonatal HIE at age of 1 year. The accuracy of serum S-100B〉5/~g/I. at day 1 and 3 after birth for predicting the prognosis of neonatal HIE was 88.1~ and 77.3~ ,respectively and the accuracy of urine S-100B〉3 μg/I, at day 3 and 7 after birth for predicting the outcome of neonatal HIE was 90. 5% and 85.7%,respectively. There was no significant difference between serum and urine S-100B for predicting the prognosis of neonatal HIE. [Conclusions] There is a elose relationship between the level of serum and urine S-100B and the severity and the prognosis of neonatal HIE. S-100B protein shows significant value in predicting the prognosis of neonatal HIE.