早产儿血清泛素羧基末端水解酶L1、神经胶质原纤维酸性蛋白与脑损伤的关系

Relationship of serum ubiquitin carboxy terminal hydrolase L1 and glial fibrillary acidic protein with brain injury in preterm infants

目的探讨早产儿血清泛素羧基末端水解酶L1(UCH-L 1)及神经胶质原纤维酸性蛋白(GFAP)与脑损伤的关系。方法选取2014年8月至2016年10月出生、胎龄<34周的早产儿130例,分别留取生后6、72 h血液样本,采用ELISA法检测血清UCH-L 1及GFAP水平。根据颅脑超声及MRI检查结果,将入选早产儿分为脑白质损伤(WMD)组、脑室周围-脑室内出血(PVH-IVH)组及无脑损伤组,比较这三组间,轻度与重度脑损伤之间早产儿血清UCH-L1及GFAP水平。结果生后6 h及72 h,无脑损伤组、PVH-IVH组及WMD组早产儿血清UCH-L1、GFAP水平的差异均有统计学意义(P<0.001);无论生后6 h还是72 h,WMD组早产儿血清UCH-L1、GFAP水平均为最高,无脑损伤组最低。PVH-IVH组和WMD组生后72 h血清UCH-L1水平较生后6 h明显降低,而血清GFAP水平较生后6 h明显增高,差异均有统计学意义(P<0.05)。生后6 h及72 h,重度PVH-IVH组及重度WMD组血清UCH-L1、GFAP水平均明显高于轻度组,差异有统计学意义(P<0.05)。结论早产儿血清UCH-L1及GFAP水平可作为早期评估脑损伤的敏感标志物,有助于判断早产儿脑损伤严重程度。

ObjectiveTo explore the relationship of serum ubiquitin carboxy terminal hydrolase L1 （UCH-L1） and glial fbrillary acidic protein （GFAP） with brain injury in preterm infants. MethodsA total of 130 premature infants with gestational age 〈34 weeks from August 2014 to October 2016 were recruited. Blood samples were collected at 6 h and 72 h after birth. The levels of serum UCH-L1 and GFAP were detected by ELISA method. According to the results of cranial ultrasound and MRI examination, the premature infants were divided into white matter damage （WMD） group, periventricular intraventricular hemorrhage （PVH-IVH） group, and no brain injury group. The levels of serum UCH-L1 and GFAP in preterm infants between the three groups, mild to severe brain injury were compared. ResultsAt 6 h and 72 h after birth, the levels of serum UCH-L1 and GFAP among no brain injury group, PVH-IVH group and WMD group were signifcantly different （all P 〈0.001）. The level of serum UCH-L1 and GFAP were the highest in the WMD group and the lowest in no brain injury group at both 6 h and 72 h after birth. The levels of serum UCH-L1 at 72 h after birth were signifcantly lower than those at 6 h after birth in PVH-IVH group and WMD group, while the levels of serum GFAP at 72 h after birth were signifcantly higher than those at 6 h after birth in both of the two groups （all P〈0.05）. The levels of serum UCH-L1 and GFAP in severe PVH-IVH group and severe WMD group were signifcantly higher than those in the mild group at 6 h and 72 h after birth （all P〈0.05）. ConclusionsThe levels of serum UCH-L1 and GFAP in preterm infants can be used as sensitive markers for early evaluation of brain injury, which can help determine the severity of brain injury in preterm infants.