神经系统特异性蛋白质在新生儿缺氧缺血性脑病中的诊断价值

Value of specific proteins of the nervous system in the diagnosis of neonatal hypoxic ischemic encephalopathy

目的 评价缺氧缺血性脑病 (HIE)新生儿脑脊液 (CSF)和血浆中神经元特异性稀醇化酶 (NSE)、S 10 0蛋白 (S 10 0 protein ,S 10 0 )、髓鞘碱性蛋白 (MBP)、肌酸磷酸激酶脑型同工酶 (CK BB)等神经系统特异性蛋白质与新生儿HIE程度及预后的关系。方法 新生儿HIE患儿 5 5例 ,无中枢神经系统疾患的患儿 16例作为对照 ,取CSF和血浆检测上述 4种神经系统特异性蛋白质水平。NSE、S - 10 0、MBP用放射免疫试剂盒检测 ,CK -BB用酶法及琼脂糖电泳法检测。存活出院的患儿定期随访。结果 CSF的NSE、S - 10 0、MBP、CK -BB及血浆NSE、CK -BB均与HIE程度相关 ,但只有CSF的神经系统特异性蛋白质才能较准确地反映患儿的远期预后 ,其中敏感性、特异性最高的指标是NSE和S - 10 0。结论 CSF的NSE和S - 10 0是判断HIE患儿脑损伤程度、预测远期预后的可靠指标。

Objective To determine some specific proteins of the nervous system such as the neuron specific enolase (NSE), S 100 protein (S 100), myelin basic protein (MBP) and creatine kinase isoenzyme BB (CK BB) in cerebrospinal fluid (CSF) and plasma of asphyxiated newborns during early stage of hypoxic ischemic encephalopathy (HIE), and its correlation with the severity of the disease and long term outcome. Methods 71 full term and near full term neonates were enrolled in the study. 16 babies without neurological disease were assigned to the control group. Another 55 babies were in the HIE group. Among them, there were 20 with mild HIE, 28 with moderate , and 7 with severe HIE. CSF and plasma specimens were obtained at 9 92 hours (mean: 33.5 hours) postnatal in the HIE group. NSE/S 100/MBP were measured by immunoradiometric assay, CK BB by agarose electrophoresis. Babies with HIE were followed up after discharged from the hospital. Neurological outcome was assessed by physical examination and Gesell developmental diagnosis. Results 80% (41/51) of the infants survived at the time of discharge were followed up for 3～13 months (mean:6.5 months). 25 infants were normal, 9 slightly abnormal, and 7 seriously abnormal. Although the plasma levels of NSE, and CK BB correlated with the degree of HIE, they could not predict accurately the long term outcome. NSE, S 100, MBP and CK BB in CSF were correlated not only to the severity of the disease, but also to the long term outcome. Among the four markers, NSE and S 100 were the most sensitive and specific in the prediction of the degree of brain injury. Conclusion NSE and S 100 in CSF are the most reliable markers for early estimation of the degree of HIE in neonates.