回顾性分析43例足月窒息新生儿脑血流动力学与血清神经元特异性烯醇化酶(S-NSE)动态变化的临床意义

Retrospective analysis of clinical significance of dynamic changes of cerebral hemodynamics and S-NSE in full term neonates with asphyxia

目的:探讨足月窒息新生儿脑血流动力学与血清神经元特异性烯醇化酶(S-NSE)动态变化的临床意义。方法:应用彩色多普勒超声动态检测43例足月窒息新生儿(窒息组)和10例足月正常新生儿(对照组)1、3、7 d大脑中动脉(MCA)的收缩期峰值流速(PSV)、舒张期末血流速度(EDV)及阻力指数(RI),同时采用化学发光免疫分析法测定窒息组新生儿1、3、7 d的SNSE和对照组1 d的S-NSE,最后严格按照中华医学会新生儿学组于2000年制定的新生儿缺氧缺血性脑病诊断依据和临床分度,将窒息组新生儿分为无缺氧缺血性脑病(HIE)组、轻度HIE组、中度HIE组及重度HIE组;并对各组的脑血流动力学参数及S-NSE进行回顾性分析。结果:(1)与对照组比较,窒息组的MCA主要表现为PSV、EDV降低,RI升高,HIE的程度越重,改变越明显;而随着治疗的进行,三者均有不同程度的恢复,HIE的程度越轻,恢复越快;(2)HIE的程度越重,S-NSE的含量越高,随着治疗的进行,S-NSE逐渐降低,HIE的程度越轻,降低越快;(3)RI和S-NSE的曲线下面积(AUC)分别是0.768、0.874,灵敏度分别为58.1%、73.5%,特异度分别为93.6%、90.5%;(4)RI与S-NSE的相关性为低度的正相关,相关系数为0.354。结论:动态检测窒息新生儿脑血流动力学和S-NSE含量,对HIE的早期诊断、早期分度及判断预后有重要意义,二者联合应用,能提高HIE诊断的准确性。

Objective： To investigate the clinical significance of dynamic changes of cerebral hemodynamics and serum neuron specific enolase（S-NSE） in full term neonates with asphyxia. Methods： Color Doppler ultrasound was applied to monitor the changes of peak systolic velocity（PSV）, end diastolic velocity（EDV） and resistance index（RI） of the middle cerebral artery（MCA） at the 1, 3 and 7 days in 43 cases of asphyxiated full term neonates（asphyxia group） and 10 cases of full-term normal neonates（control group）. Moreover, the serum NSE at the 1, 3 and 7 days in the asphyxia group and the 1 day in the control group were available. In strict accordance to the neonatal hypoxic ischemic encephalopathy（HIE） clinical diagnosis and grading standard made in 2000 by the neonatal study group of Chinese Medical Association, the newborns in the asphyxia group were divided into non-HIE group, mild HIE group, moderate HIE group and severe HIE group. Retrospective analysis was performed on cerebral hemodynamic parameters and S-NSE values between each group. Results： Compared with the control group, the asphyxia group showed decreased PSV and EDV, and increased RI with the deterioration of HIE degrees. After treatment, the three parameters became bettered when HIE was less severe, the recovery was more rapid. S-NSE value increased significantly with deterioration of HIE degrees. After treatment, S-NSE value gradually decreased when HIE was less severe, the decrease was more rapid. The areas under the curve（AUC） of RI and S-NSE were 0.768 and 0.874. The sensitivity was 58.1% and 73.5%, and the specificity was 93.6% and 90.5%, respectively. RI and S-NSE showed low positive correlation with a correlation coefficient of 0.354. Conclusion： Dynamic detection of neonatal cerebral hemodynamics and S-NSE value is important for early diagnosis, grading and prognosis estimation of HIE. This combination can improve the accuracy of HIE diagnosis.