窒息新生儿血清炎症因子及振幅整合脑电图动态监测的临床意义

Artery serum inflammatory factors and amplitude-integrated electroencephalogram of neonates with perinatal asphyxia associated with short term neurological outcome

目的探讨肿瘤坏死因子α（TNF-α）、高迁移率组蛋白B1（HMGB1）、神经元特异性烯醇化酶（NSE）和振幅整合脑电图（aEEG）判断窒息新生儿脑损伤及近期预后的临床应用价值。方法选取我院2013年1~12月出生、经规范新生儿复苏转入新生儿重症监护病房的足月窒息新生儿为窒息组,再按窒息程度分为轻度窒息组和重度窒息组;选取同期出生并入住新生儿重症监护室的无窒息高危儿为对照组。比较各组患儿脐动脉血和生后不同时间动脉血TNF-α、HMGB1、NSE水平,以及aEEG的动态变化情况。结果共纳入轻度窒息组24例,重度窒息组8例,对照组32例。轻度和重度窒息组脐动脉血和生后1天血清TNF-α、HMGB1、NSE水平均高于对照组,重度窒息组高于轻度窒息组,差异有统计学意义（P〈0.05）。所有监测时间点TNF-α和HMGB1、TNF-α和NSE、HMGB1和NSE三者的总体相关系数分别为0.938、0.978和0.948（P均〈0.001）,成明显正相关。生后6 h内aEEG异常新生儿生后7天内血清TNF-α、HMGB1、NSE水平均高于aEEG结果正常者（P〈0.05）。aEEG持续异常或进行性恶化的窒息新生儿多预后不良。结论动态监测TNF-α、HMGB1、NSE水平及aEEG对窒息新生儿脑损伤的早期诊断、程度判断及患儿的近期预后有重要指导意义。

Objective To study the diagnostic and prognostic value of tumor necrosis factor-or （ TNF-α）, integrated high-mobility group protein box 1 （HMGB1）, neuron-specific enolase （NSE） and amplitude electroencephalogram group （aEEG） on neonatal brain injury and short term outcome of neonates with perinatal asphyxia. Methods Term infants born at our Hospital from January to December 2013 and admitted to neonatal intensive care unit （NICU） were recruited in the study. Infants with neonatal asphyxia were divided into mild asphyxia group and severe asphyxia group according to the degree of asphyxia. High risk term infants without neonatal asphyxia were assigned to control group. Serum level of TNF-α, HMGB1, NSE and aEEG of the three groups were studied. Results There were 24 cases in the mild asphyxia group, 8 cases in the severe asphyxia group and 32 cases in the control group. The levels of TNF-α, HMGB1 and NSE on day one in asphyxia group were significantlv higher than those in control group （P 〈 0.05 ）, and which in severe group were significantly higher than those in mild asphyxia group （P 〈 0.05 ）. The correlation coefficients of the TNF and HMGB1, TNF and NSE, HMGB1 and NSE were respectively 0. 938 and 0. 978 and 0. 948 （ P 〈 0. 05 ）, so there were significant positive correlations. The levels of TNF-α, HMGB1 and NSE in abnormal aEEG group within 6 hours after birth were significantly higher than those in normal aEEG group （P 〈 0. 05）. Those wit sustained abnormal aEEG or those asphyxiated newborn newborns with progressive deterioration would have poor prognosis. Conclusions Monitoring the level of TNF-α, HMGB1, NSE and aEEG of the newborns after perinatal asphyxia have important predictive clinical value on the early diagnosis, grading and prognosis of brain injury.