脑红蛋白及神经特异性烯醇化酶在早产儿脑损伤中的临床意义

Relationship of serum neuroglobin and neuron-specific enolase level in preterm infants with brain damage

目的：探讨脑红蛋白（ neuroglobin,Ngb）、神经元特异性烯醇化酶（ neuron specific enolase, NSE）在早产儿脑室周围白质软化（ periventricular leucumalacia,PVL）、脑室周围-脑室内出血（ periventricu-lar-intraventricular hemorrhage,PVH-IVH）的临床意义。方法选择2010年1月至2013年5月收入广州市妇女儿童医疗中心、花都区妇幼保健院、东莞太平医院NICU胎龄〈34周的早产儿241例,根据超声结果及纠正胎龄40周头颅MRI的检查结果分为脑无损伤组、PVL组、PVH-IVH组。于生后12 h、3 d、7 d、14 d测定Ngb、NSE,比较不同时间段各组间血清Ngb、NSE的水平,分析其临床意义。结果共选取早产儿241例,头颅超声/MRI显示脑无损伤162例,PVH-IVH 50例,PVL 20例,PVL并PVH-IVH 9例。生后12 h及3 d,PVL组及PVH-IVH组Ngb明显高于脑无损伤组（P均〈0．05）,PVL组Ngb高于PVH-IVH组（P〈0．05）；7 d及14 d,PVH-IVH组与脑无损伤组比较差异无统计学意义（P均〉0．05）,PVL组Ngb仍然明显高于脑无损伤组及PVH-IVH组（P〈0．05）。生后12 h及3 d,PVL组及PVH-IVH组NSE明显高于脑无损伤组（P均〉0．05）,PVL组与PVH-IVH组比较差异无统计学意义（P〈0．05）；7 d及14 d,PVH-IVH组与脑无损伤组NSE比较差异无统计学意义（ P均〉0．05）, PVL组与 PVH-IVH组比较差异无统计学意义（P〈0．05）。结论在早产儿脑损伤中,生后12 h、3 d内的血浆Ngb、NSE增高对判断是否发生早产儿脑损伤及PVL具有临床意义。

Objective To study the relationships of serum neuroglobin and neuron-specific enolase level with periventricular hemorrhage-intraventricular hemorrhage （ PVH-IVH） and periventricular leucumalacia （ PVL） in preterm infants. Methods There were 241 cases of preterm infants whose gestational age was less than 34 weeks and were admitted in NICU of Guangzhou Women and Children′s Medical Center, Guangzhou Huadu District Matermal and Child Health Hospital and Dongguan Taiping Hospital from Jan. 2010 to May. 2013, enrolled in the study. The serum level of neuroglobin and neuron-specific enolase were detected within 12 hours and on the 3 d, 7 d, 14 d after birth. Cranial ultrasound was preformed 2,3 d, 1week, 2weeks, 3weeks, and 4 weeks after birth. They also received Cranial MRI examination before discharge or when the correct gestational age reached 40 weeks. All 241 cases were divided into 3 groups （ no brain damage group, PVH-IVH group and PVL group） according to the result of cranial US and MRI. The differences of the serum levels of neuroglobin and neuron-specific enolase among each groups were compared. Results The results of cranial ultrasound and /or MRI showed： 162 cases had no brain damage （ in no brain damage group） , 50 cases had PVH-IVH （ in PVH-IVH group） , and 20 cases had PVL, 9 cases had PVL and PVH-IVH （ both in PVL group） . Within 12 h and 3 d after birth, the serum levels of neuroglobin in PVL group and PVH-IVH group was significantly higher than those in no brain damage group （P〈0. 05）, and the serum levels of neuroglobin＆amp;nbsp;in PVL group were signigicantly higher than those in PVH-IVH group （ P〈0. 05 ） . On 7 d and 14 d after birth, the serum levels of neuroglobin were no significant difference between PVH-IVH group and no brain damage group （ P〈0. 05 ） , and there were still significantly higher than those in no brain damage group and PVH-IVH group （all P〉0. 05）. The serum levels of neuron-specific enolase within 12 h and 3 d after birth in PVH-IVH group and PVL group were significantly higher than those in no brain damage group （ P〈0. 05 ） , and there were no significant difference between PVL group and PVH-IVH group （P〈0. 05）. On 7 d and 14 d after birth, the serum levels of neuron-specific enolase in PVL group were no significant difference compared with PVH-IVH group and no brain damage group （all P〉0. 05）. Conclusion The increased serum levels of neuroglobin and neuron-specific enolase in preterm infants within 12 h and 3 d after birth would have certain clinical significance for judging whether early brain damage and PVL would happen.