联合检测GFAP、NSE、hs-CRP对新生儿脑损伤的临床应用评价

Clinical application of PCT,NSE,hs-CRP and GFAP combined detection in evaluation of neonatal brain injury

目的探讨联合检测胶质纤维酸性蛋白(GFAP)、神经元烯醇化酶(NSE)、超敏C反应蛋白(hs-CRP)对新生儿脑损伤的临床应用效果。方法选取孕母无并发症或内科疾病的出生2~7 d足月新生儿276例为研究对象,入组后均取股静脉血3 m L进行血浆GFAP、NSE、hs-CRP水平的检测,同期对新生儿NABA评分进行检测,并行MRI检查确定脑损伤情况,并根据检测结果分为脑损伤组(n=82)和非脑损伤组(n=194)。比较两组血浆GFAP、NSE、hs-CRP水平以及NABA评分比较,分析血浆GFAP、NSE、hs-CRP水平与新生儿NABA评分和脑损伤发生率的关系,并采用ROC曲线分析血浆GFAP、NSE、hs-CRP水平单独和联合评估新生儿脑损伤的价值。结果与非脑损伤组比较,脑损伤组血浆GFAP、NSE、hs-CRP水平均升高,NABA评分则降低(P<0.05)。与脑损伤组NABA评分≥35分患儿比较,脑损伤组NABA评分<35分患儿血浆NSE、hs-CRP、GFAP水平均升高(P<0.05)。新生儿血浆NSE、hs-CRP、GFAP水平与其NABA评分均呈负相关(r=-0.845、-0.887、-0.873,P<0.05),与其脑损伤发生率则呈正相关(r=0.811、0.875、0.826,P<0.05)。ROC曲线分析结果显示,新生儿血浆GFAP、NSE、hs-CRP水平评估其脑损伤的准确性均较高,其中以三者联合评估脑损伤的准确性最高。结论新生儿血浆GFAP、NSE、hs-CRP水平与其NABA评分和脑损伤均相关,且三者联合评估新生儿脑损伤的价值良好,可能作为新生儿脑损伤评估的参考指标。

Objective To investigate the clinical application of procalcitonin （ PCT）, neuron enolase （ NSE）, high sensitivity C -reaetive protein （HsCRP） and glial fibrillary acidic protein （GFAP） combined detection in evaluation of neonatal brain injury. Methods A total of 276 cases of neonates （ aged 2 to 7 days） without maternal complications or medical diseases were enrolled in the study. Femoral vein blood samples were taken to assesssSerum PCT, NSE, HsCRP and GFAP levels. Neonatal NABA score in the same time were measured, and MRI detection were taken to determine the occurrence of brain injury. The neonates were divided into brain injury group （ n = 82 ） and non - brain injury group （ n = 194） according to MRI results. The serum PCT, NSE, HsCRP and GFAP levels and NABA score of 2 groups were com- pared. Con＇elations between serum PCT, NSE, HsCRP and GFAP with NABA score and brain injury occurrence were ana- lyzed. And the values of serum PCT, NSE, HsCRP, GFAP level in evaluating the neonatal brain injury were analyzed by ROC curve. Results Compared with the non -brain injury group, serum PCT, NSE, HsCRP and GFAP levels in the brain injury group were signifieantly increased, while NABA score signifieantly reduced （P 〈 O. 05 ）. Compared with the neonate with NABA seore I〉35 in the brain injury group, serum PCT, NSE, HsCRP and GFAP levels of the neonate with NABA score 〈 35 in the brain injury group were significantly higher （P 〈 0. 05）. Serum PCT, NSE, HsCRP and GFAP levels in neonates were negatively correlated with NABA scores （ r = - O. 872, - O. 845, - 0. 887, - 0. 873, P 〈 O. 05 ） , and positively correlated with brain injury oecurrence （r =0. 842, 0. 811,0. 875, O. 826, P 〈0. 05）. ROC curve analysis showed that aceuracies of neonatal serum PCT, NSE, HsCRP, GFAP levels assessing the brain injury were high, of which the accuracy of 3 factors in combine assessing the brain injury was the highest. Conclusion Serum PCT, NSE, HsCRP and GFAP levels in neonates are correlated with NABA seore and brain injury. The combined deteetion of 3 faetors assess- ing neonatal brain injury is good.