经颅彩色多普勒超声联合血清NSE在新生儿缺血缺氧性脑病早期诊断中的意义

Application Values of Transcranial Color Doppler Ultrasonography Combined with Serum NSE Detection in Early Diagnosis of Neonatal Hypoxic-Ischemic Encephalopathy

目的:探讨经颅彩色多普勒超声联合血清神经元特异性烯醇化酶(NSE)在新生儿缺血缺氧性脑病(HIE)早期诊断中的应用。方法:选取我院收治的42例HIE患儿作为研究组,另选同期出生30例健康新生儿为对照组;采用酶联法检测两组新生儿血清NSE水平,经颅超声检查其脑血流动力学Vd、Vs及RI值,并通过采用ROC曲线进行分析血清NSE水平和经颅超声监测脑血流动力学Vd、Vs及RI值及联合诊断HIE的准确性和特异性。结果:对照组新生儿出生后6h、12h及24h血清NSE水平均无明显差异(P>0.05),研究组出生后6h血清NSE水平明显高于出生后24h(P<0.05);同时研究组各时间点NSE水平均显著高于对照组(P<0.001);对照组新生儿出生后6h、12h及24h的Vd、Vs及RI值比较无明显差异(P>0.05),且研究组各时间点Vs、RI值均显著高于对照组,Vd显著低于对照组(P<0.001);ROC曲线显示,在HIE患儿出生后12h血清NSE诊断预测HIE的特异度和灵敏度最高,分别为71.2%和100%;经颅超声监测Vd、Vs及RI诊断预测HIE的灵敏度、特异度以出生后6h最高,分别为91.3%、89.7%,90.8%和88.6%,94.8%、91.2%;而血清HSE和经颅超声联合诊断出生6h后HIE的灵敏度和特异度最高,为100%和96.1%。结论:经颅彩色多普勒超声联合血清NSE检测可有效提高对HIE诊断预测的灵敏度和特异性度,可为HIE早期诊断提供依据。

ABSTRACT Objective： To explore the application values of transcranial color Doppler ultrasonography combined with serum neuron specific enzyme （NSE） in the early diagnosis of neonatal hypoxic-ischemic encephalopathy （HIE）. M^j~ods： 42 cases of newborns with HIE in our hospital were selected as the study group, and another 30 cases of healthy newborns born during the same period were selected as the control group. The serum NSE levels of the newborns in the two groups were detected by enzyme linked immunosorbent assay method. The Vd, Vs and RI values of cerebral blood flow dynamics were detected by transcranial color Doppler ultrasonography. ROC curve analysis was applied to analyze the accuracies and specificities of Vd, Vs and RI values by transcranial Doppler ultrasonography and serum NSE levels and the combination of the two methods in the diagnosis of HIE. Results： There were no significant differences in serum NSE levels of newborns in the control group at 6h, 12h and 24h after birth （P〉0.05）. But the serum NSE levels of newborns in study group was significantly higher at 6h after birth than at 24h after birth （P〈0.05）. Meanwhile, the levels of NSE of the study group at each time point were significantly higher than those of the control group （P〈0.001）. No significant difference was found in the values ofVd, Vs and RI of newborns of the control group at 6h, 12h and 24h after birth（P〉0.05）. Moreover, the values of Vs and RI of the study group at each time point were significantly higher than those of the control group, while the Vd values were significantly lower than those of the control group （P〈0.001）. The ROC curve showed that the specificity and sensitivity of NSE reached to the highest in the diagnosis of HIE at 12h after birth, with 71.2% and 100% respectively. But the sensitivity and specificity ofVd, Vs and R/values by transcranial Doppler ultrasonography were the highest at 6h after birth, respectively 91.3%, 89.7%, 90.8% and 88.6%, 94.8%, 91.2%. As for the combination of serum NSE detection and transcranial Doppler ultrasonography, the sensitivity and specificity got to the highest at 6h after birth, with 100% and 96.1% respectively. Conclusion： Transcranial color Doppler ultrasound combined with serum NSE detection can effectively improve the sensitivity and specificity of HIE diagnosis and prediction, and can provide a basis for early diagnosis of HIE, so it is worthy of clinical application.