脑损伤新生儿血清神经元特异性烯醇化酶动态变化及临床意义

Clinical significance of dynamic change of serum neuron specific enolase level in neonates with brain injury

目的了解缺氧缺血性脑病(HIE)和早产儿脑损伤(PBL)新生儿血清神经元特异性烯醇化酶(NSE)水平变化及临床意义。方法选取2013年10月至2015年5月出生后第1天在该院新生儿病房住院的足月HIE患儿25例(HIE组)及PBL患儿15例(PBL组)作为观察组;将依据1分钟Apgar评分及病史有无宫内窘迫但未诊断为HIE的新生儿作为HIE组的单纯缺氧对照组(33例)和健康对照组(20例);将无脑损伤的早产儿设为PBL组的无脑损伤对照组(20例)。应用电化学发光法测定出生后第1、5天新生儿血清NSE水平。结果 HIE组患儿同时间点血清NSE水平均高于单纯缺氧对照组和健康对照组,差异均有统计学意义(P<0.05);单纯缺氧对照组患儿血清NSE水平高于健康对照组,但差异无统计学意义(P>0.05)。PBL组患儿同时间点血清NSE水平高于无脑损伤对照组,但差异无统计学意义(P>0.05)。各组研究对象出生后第5天平均血清NSE水平均低于出生后第1天,差异均有统计学意义(P<0.05)。结论血清NSE水平可作为HIE的辅助诊断依据,但对诊断PBL无预测价值。

Objective To understand the change and clinical significance of serum neuron specific enolase（NSE）level in preterm neonates with hypoxic ischemic encephalopathy（HIE） and preterm brain lesion（PBL）. Methods Twenty-five full term neonates with HIE（HIE group） and 15 patients with PBL（PBL group） served as the observation group;the neonates with and without intrauterine distress according to 1 min Apgar score,but without diagnosing HIE,served as the simple anoxia control group（33cases）and healthy control group（20 cases）;the preterm neonates without brain injury were taken as the non-brain injury control group in the PBL group（20 cases）. Serum NSE level on postnatal 1,5 d was determined by using ECISA. Results The serum NSE level at the same time point in the HIE group was higher than that in the simple anoxia control group and healthy control group,the difference was statistically significant（P〈0.05）;the serum NSE level in simple anoxia control group was higher than that in the healthy control group,but the difference had no statistical significance（P〉0.05）. The serum NSE level at the same time point in the PBL group was higher than that in the non-brain injury control group,but the difference had no statistical significance（P〉0.05）.The average serum NSE level on postnatal 5 d in various study groups was lower than that on postnatal 1 d,the difference was statistically significant（P〈0.05）. Conclusion Serum NSE may be used as an assisted diagnostic basis of HIE,but has no predictive value for diagnosing PBL.