脐血皮质醇测定对评价新生儿缺氧缺血性脑病的临床价值

The clinical value of cord blood cortisol determination in evaluating neonatal hypoxic-ischemic encephalopathy

目的探讨新生儿缺氧缺血性脑病(HIE)脐血皮质醇(COR)水平的变化,为合理干预提供理论依据。方法选择成都市第一人民医院新生儿科病房2014年1月至2017年5月足月HIE患儿66例作为研究对象,根据HIE诊断标准分为轻度HIE组44例、中度HIE组15例、重度HIE组7例;另外选择健康足月新生儿50例作为健康对照组。检测各组新生儿脐血血清COR水平并进行比较;在出生第14天进行20项新生儿行为神经测定(NBNA)评分,对COR水平及出生第14天的NBNA进行相关性分析。结果轻、中、重度HIE组COR水平均高于健康对照组(nmol/L:667.37±156.77、923.50±198.44、1 174.10±223.84比453.47±142.14,均P<0.05),且HIE临床分级越严重,脐血COR水平越高;相关性分析显示,脐血COR水平与出生第14天NBNA评分呈显著负相关(r=-0.850,P<0.01)。结论脐血COR水平可作为HIE早期诊断和病情评估的参考指标,与HIE临床分级有较好的相关性,同时也可作为近期预后的指标。

Objective To investigate the changes of cord blood cortisol（COR） levels in neonates with hypoxic-ischemic encephalopathy（HIE） and provide a theoretical basis for rational intervention.Methods 66 full-term HIE children admitted in Department of Neonatology,Chengdu First People＇s Hospital from January 2014 to May 2017 were selected as research objects.According to HIE diagnostic criteria,they were divided into mild HIE group（44 cases）,moderate HIE group（15 cases）,and severe HIE group（7 cases）.Another 50 healthy fullterm newborns were selected as healthy control group.Cord blood serum COR levels of each group were detected and compared.20 items of neonatal behavioral neurological assessment（NBNA） were performed on the 14 th day of birth.Correlation analysis was conducted on the COR level and the NBNA of the 14 th day.Results The levels of COR in mild,moderate and severe HIE groups were higher than those in healthy control group（nmol/L：667.37±156.77,923.50±198.44,1 174.10±223.84 vs.453.47±142.14,all P 〈0.05）,and the more serious of HIE clinical grading,the higher of the cord blood COR level.The correlation analysis showed that there was a significant negative correlation between cord blood COR value and NBNA score on 14 th day of birth（r =-0.850,P 〈0.01）.Conclusion The cord blood COR level can be used as an early reference index of HIE and a recent prognostic indicator,and it has a good correlation with HIE clinical grading.