S-100B蛋白动态变化对窒息新生儿脑损伤诊断价值的研究

A study on the dynamic changes of S-100 B protein for the early diagnosis of neonatal hypoxic ischemic encephalopathy

目的探讨S-100B蛋白水平动态变化对早期诊断新生儿缺氧缺血性脑病(HIE)的价值。方法选择2009年5月至2011年5月我院新生儿重症监护病房收治的窒息新生儿为病例组,同期随机选取我院出生的40例健康新生儿为对照组,分别于生后6 h内、(72±6)h取血检测血清S-100B蛋白水平,并与7天内最终确诊HIE的程度进行对照分析。结果轻度窒息组和重度窒息组生后6 h内血清S-100B蛋白水平均高于对照组[(0.40±0.24)μg/L、(0.89±0.34)μg/L比(0.28±0.14)μg/L],重度窒息组高于轻度窒息组,P均<0.01。生后72 h,轻度窒息组已恢复至对照组水平(P>0.05),重度窒息组仍高于轻度窒息组[(0.44±0.21)μg/L比(0.26±0.10)μg/L,P<0.01]。窒息合并颅内出血患儿生后6 h内、72 h血清S-100B蛋白水平均高于重度窒息组[(2.61±1.08)μg/L比(0.89±0.34)μg/L,(1.64±0.71)μg/L比(0.44±0.21)μg/L,P<0.01]。生后6 h内血清S-100B蛋白水平诊断HIE的敏感度及阴性预测值分别为97.4%、97.7%,但特异度及阳性预测值较低。生后72 h血清S-100B蛋白水平诊断HIE的特异度及阳性预测值均为100%,但敏感度及阴性预测值较低。故以6 h内血清S-100B蛋白水平作为HIE初筛指标可以减少漏诊,结合72 h血清S-100B蛋白水平可以提高中重度HIE的诊断特异度。结论动态监测新生儿窒息后72 h内血清S-100B蛋白水平可作为早期评价脑损伤的敏感指标,为HIE的早期诊断及干预治疗提供客观依据。

Objective To study the dynamic changes of the S-100B protein level for early diagnosis of neonatal hypoxic-ischemic encephalopathy （HIE）. Methods From May 2009 to May 2011, neonates with mild-to-severe asphyxia admitted to neonatal intensive care unit and 40 healthy neonates born in the hospital were enrolled into the study. Serum S-100B protein levels within 6 hours after birth and （72 ± 6 ） h were compared between these groups and the diagnosis value for HIE were assessed. Results Mild asphyxia group and severe asphyxia group had higher S-100B protein levels than that of the the control group within 6 hours after birth [ （0. 40 ±0. 24） μg/L, （0. 89 ±0. 34） μg/L vs. （0. 28 ± 0. 14）μg/L, P 〈 O. 01 ], severe asphyxia group even higher than the mild group. 72 h after birth, S-100B protein levels in mild asphyxia group showed no significant differences than the control group （ P 〉 0. 05 ）, severe asphyxia group still had higher S-100B protein level than the mild group [ （0. 44 0. 21 ） p,g/L vs. （0. 26 ±0. 10） μg/L, P 〈0. 01 ]. S-100B protein levels in neonates with asphyxia and intracranial hemorrhage were higher than that of the severe asphyxia group within 6 h and 72 h after birth [（2.61 ±1.08） μg/Lvs. （0.89 ±0.34） μg/L, （1.64 ±0.71） p,g/Lvs. （0.44 ±0.21）μg/L, P 〈0. 01 ]. The sensitivity and negative predictive value of S-100B protein level for the diagnosis of HIE within 6 h after birth were 97.4% and 97.7%, but specificity and positive predictive value were lower. The specificity and positive predictive value of S-100B protein level for the diagnosis of HIE at 72 h were 100%, but sensitivity and negative predictive value were lower. Therefore, serum S-100B protein level within 6 h could be considered for use as a preliminary screening test for HIE, combining with resampling at 72 h to improve the specificity for the diagnosis of severe HIE. Conclusions Serum S-100B protein level in asphyxia neonates could be used as a sensitive indicator （ index ） of early brain objective evidence for early diagnosis and intervention of HIE. damage and