动态监测血清caspase-3和NSE在新生儿缺氧缺血性脑病诊治中的价值

The value of dynamic monitoring on caspase-3 and NSE in the diagnosis and treatment of neonatal hypoxic ischemic encephalopathy

目的动态监测不同患病程度、不同病程阶段缺氧缺血性脑病(hypoxic-ischemic encephalopatly,HIE)新生儿半胱氨酸天冬氨酸蛋白酶3(caspase-3)和神经元特异性烯醇化酶(neuron specific enolase,NSE)水平变化及临床意义。方法随机选取明确诊断为HIE的患儿67例,轻度HIE 23例,中度HIE 23例,重度HIE 21例,另选20例同期分娩正常足月的新生儿为对照组。各组新生儿均在出生后第1天、第3天和第7天采集股静脉血,测定血清caspase-3和NSE水平的变化。结果各组caspase-3水平在第1天、第3天和第7天均呈先升高后降低的趋势,但对照组升高和降低的幅度很小,而轻度HIE组、中度HIE组和重度HIE组升高和降低的幅度较大,病情越重波动越大;对照组和轻度HIE组NSE水平呈先升高后降低的趋势,但中度HIE组和重度HIE组NSE水平呈逐渐下降趋势;4组caspase-3和NSE水平组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.01)。结论caspase-3和NSE均参与了HIE的病理生理过程,其浓度水平与HIE患儿病情的轻重和病程进展有关,病情越重血清中2项指标水平越高。动态观测2项指标变化趋势,将有助于HIE的早期诊断、病情监测及判断预后。

Objective To dynamically observe caspase-3and neuron specific enolase（NSE）of the neonate with the different stage of hypoxic ischemic encephalopathy and to explore the related significance.Methods Sixty-seven of children with hypoxic ischemic encephalopathy were randomly selected,in which mild,moderate and severe group were 23,23,21 respectively.Twenty neonates of full term normal were as control group.All the neonates in 1day,3days,7days after their birth were taken blood to detect the serum levels of caspase-3and NSE.ResultsCaspase-3levels in each group showed a trend of increase in first days,third days and seventh days,but the amount of the increase and decrease in the control group was very small,while the change range was very big in the mild HIE group,moderate HIE group and severe HIE group,and the heavier the condition the greater the fluctuation.The level of NSE in the control group and the mild HIE group showed a trend of first increasing and then decreasing.But the NSE level of moderate HIE group and severe HIE group showed a gradual downward trend.There is significant difference between the groups,the time points and their interaction（P〈0.01）.Conclusion Both caspase-3and NSE were involved in the pathophysiological process of HIE,the levels of caspase-3 and NSE were closely related to the severity and the course of HIE progression.The more severity of the HIE,the higher level of the two indicators.Dynamic monitoring of the caspase-3and NSE will help the early diagnosis,disease monitoring and prognosis of the neonate HIE.