血清神经元特异性烯醇化酶与围产儿缺氧缺血性脑病相关性研究

Study on correlation between serum neuron-specific enolase and parinatal hypoxic-ischemic encephalopathy

目的:分析血清神经元特异性烯醇化酶(NSE)的动态浓度与新生儿缺氧缺血性脑病(HIE)不同时期临床特点的相关性。方法 :以新生儿HIE患儿107例按2005年新生儿缺血缺氧性脑病诊断标准分为HIE轻、中、重度3个亚组,同期入室新生儿30例为对照组,分别动态血清NSE定量检测,观察记录新生儿HIE病例的临床症状资料进行统计学分析。结果:中、重度亚组血清NSE水平明显高于对照组与轻度HIE亚组,差异有统计学意义(P<0.05)。血清NSE与NBNA变化水平显著负相关(P=0.000),与血清NSE浓度升高具统计学意义的临床表现有:兴奋与抑制的意识状态、肌张力下降或强直、吸吮反射消失、瞳孔不等和/或对光反射迟钝等。死亡患儿血清NSE浓度变化明显高于存活组,差异有统计学意义(P<0.05)。出现后遗症病例HIE急性期NSE浓度高于无后遗症组水平,差异有统计学意义(P<0.05)。结论 :血清NSE浓度是反映新生儿HIE严重程度的敏感生化指标,NSE浓度变化趋势是新生儿HIE预后评估的有效指标之一。

Objective： To analyze the correlation between dynamic concentration of serum neuron - specific enolase （NSE） and clinical characteristics of neonatal hypoxic -ischemic encephalopathy （HIE） during different periods. Methods： One hundred and seven ne- onates with HIE were divided into mild HIE subgroup, moderate HIE subgroup, and severe HIE subgroup according to neonatal HIE diagnos- tic criteria formulated in 2005, thirty neonates who went to the hospital during the same period were selected as control group; dynamic serum neuron - specific enolase quantitative determination was perdormed, the clinical symptoms of neonates with HIE were observed and recorded, then the data were analyzed statistically. Results： The levels of serum neuron - specific enolase in moderate HIE subgroup and severe HIE subgroup were statistically significantly higher than those in control group and mild HIE subgroup （ P 〈 0.05 ） . There was a significantly negative correlation between serum neuron - specific enolase and change of NBNA level （P = 0. 000）, the clinical manifestations which were significantly correlated with increase of serum neuron - specific enolase concentration included ： conscious states of exciting and suppression, decrease or rigidity of muscular tension, disappear of sucking reflex, anisocoria and/or bluntness of light reflex. The concentration of serum NSE in death group was statistically significantly higher than that in survival group （P 〈 0.05） . The concentration of neuron - specific eno- lase during acute phase in patients with sequela was statistically significantly higher than that in patients without sequela （ P 〈 0. 05 ） Conclusion： Serum neuron - specific enolase concentration is a sensitive biochemical indicator to reflect severity of neonatal HIE, change trend of NSE concentration is one of effective assessment indicator of prognosis of neonates with HIE.