血清肿瘤坏死因子-α、神经元特异性烯醇化酶与新生儿缺氧缺血性脑病病情严重程度的相关性分析

The correlation analysis of serum tumor necrosis factor-α and neuron-specific enolase and the degree of hypoxic-ischemic encephalopathy

目的探讨血清肿瘤坏死因子（TNF）-α、神经元特异性烯醇化酶（NSE）与新生儿缺氧缺血性脑病（HIE）病情严重程度的关系。方法选择46例HIE患儿作为HIE组，选择足月新生儿30例作为对照组，检测HIE组急性期和恢复期及不同临床分度、对照组的血清TNF-α与NSE水平，分析血清TNF-α与NSE水平和新生儿HIE病情严重程度的关系。结果HIE组急性期血清TNF-α和NSE水平分别为（156．3±28．8）ng／L、（21．5±3．6）μg／L，HIE组恢复期分别为（80．7±26．1）ng／L、（10．6±1．7）μg／L，对照组分别为（76.3±24．4）．g／L、（9．4±1．6）μg／L。HIE组急性期血清TNF-α与NSE水平均显著高于HIE组恢复期和对照组，差异均有统计学意义（P〈0．05），HIE组恢复期和对照组比较差异无统计学意义（P〉0．05）。轻度HIE患儿血清TNF-α与NSE水平分别为（88．5±25．6）ng／L、（9．7±2．4）μg/L，中度HIE患儿分别为（150．1±16．5）ng／L、（17．8±3．6）μg／L，重度HIE患儿分别为（197．3±30．2）ng/L、（23．6±4.3）μg/L。随着临床分度的加重，血清TNF-α、NSE水平呈逐渐增加的趋势，各临床分度间比较差异有统计学意义（P〈0．05）；轻度HIE患儿血清TNF-α与NSE水平与对照组比较差异无统计学意义（P〉0．05），中、重度HIE患儿则明显高于对照组，差异有统计学意义（P〈0．05）。Spearman等级相关分析显示，血清TNF-α和NSE水平与HIE临床分度均呈正相关（r=0．54、0．57，P〈0．01或〈0．05）；Pearson相关分析显示，TNF-α与NSE也呈正相关（r=0．46，P〈0．05）。结论HIE患儿TNF-α和NSE升高且与新生儿HIE的严重程度呈正相关，能较敏感地反映HIE患儿病情严重程度，可以作为新生儿HIE病情严重程度的临床评估指标。

Objective To investigate the correlation between serum tumor necrosis factor （TNF）-α ,neuron-specific enolase （NSE）and the degree of hypoxic-ischemic encephalopathy （HIE）. Methods Forty-six HIE patients in acute and convalescent stage and 30 full-term newborn infant were enrolled in this study. The level of serum of TNF-α and NSE were detected. The relationship between TNF-α , NSE level and severity of HIE was analyzed. Results The level of serum TNF-α and NSE in acute stage of HIE group were （156.3 ± 28.8 ） ng/L and （21.5 ± 3.6）μg/L,in convalescent stage of HIE group were （80.7 ± 26.1 ） ng/L and （ 10.6 ± 1.7） μg/L, and in control group were （76.3 ±24.4） ng/L and （9.4 ± 1.6） μg/L. The level of serum TNF-α and NSE in acute stage of HIE group were significantly higherthan those in convalescent stage of HIE group and control group （P 〈 0.05）. The level of serum TNF-α and NSE in convalescent stage of HIE group had no significant difference compared with those in control group （P 〉 0.05 ）. The level of serum TNF-α and NSE in mild HIE group were （ 88.5 ± 25.6 ） ng/L and （9.7 ± 2.4） μg/L,in moderate HIE group were （150.1 ± 16.5） ng/L and （17.8 ±3.6）μg/L,and in severe HIE group were （197.3 ± 30.2） ng/L and （23.6 ± 4.3）μg/L. The level of TNF-α and NSE were increased with the aggravation of HIE and there had significant difference among different degree of HIE（P 〈 0.05 ）. The level of serum TNF-α and NSE in mild HIE group and control group had no significant difference （P 〉 0.05 ）, and there had significant difference between moderate HIE group ,severe HIE group and control group （P 〈 0.05 ）. Spearman rank correlation analysis showed that the level of TNF-α and NSE had positive correlation with the degree of HIE （r = 0.54,0.57, P 〈 0.01 or 〈 0.05 ）. Pearson correlation analysis showed that the level of TNF-α had positive correlation with the level of NSE （r = 0.46, P 〈 0.05）. Conclusions The variation of TNF-α and NSE level in HIE newborn infant is parallel to the severity of the disease, which can sensitively reflect the severity of HIE. Therefore, TNF-α and NSE may be used as vital indexes for the evaluation of the severity of HIE.