血清褪黑素检测在早产儿脑损伤中的临床意义

Clinical significance of serum melatonin levels in preterm infant brain injury

目的探讨血清褪黑素对早产儿脑损伤的诊断及病情严重程度评估的临床价值。方法选取早产儿64例,根据早产儿脑损伤诊断标准分为三组,34例早产儿无脑损伤(对照组),24例轻度脑损伤(轻度脑损伤组),6例重度脑损伤(重度脑损伤组)。采用酶联免疫吸附试验检测各组血清中褪黑素的水平,并比较血清中褪黑素的水平在脑损伤组和对照组、轻度和重度脑损伤组之间的差异,应用受试者工作特征(ROC)曲线分析褪黑素对早产儿脑损伤诊断的敏感度、特异性。所有早产儿均在矫正胎龄40周时行NBNA检测。结果脑损伤组褪黑素(72.71±8.99,94.50±10.07)pg/m L水平均明显高于对照组(66.42±9.34)pg/m L,P<0.05;重度脑损伤组褪黑素(94.50±10.07)pg/m L水平明显高于轻度脑损伤组(72.71±8.99)pg/m L,P<0.05;褪黑素水平诊断早产儿脑损伤的曲线下面积(AUC)为0.76;95%可信区间为(0.635,0.886);截断值为69.5 pg/m L,敏感度为86.7%,特异度为68.4%,P<0.05。褪黑素水平与矫正胎龄40周的NBNA评分呈负相关(r=-0.518,P<0.05)。结论褪黑素对早产儿脑损伤的诊断及病情严重程度评估有一定的临床价值。

Objective To explore the predictive value of serum melatonin levels in severity of brain injury in preterm infants. Methods According to the diagnostic criteria of brain injury in premature infants,34 cases of premature infants without brain injury（ control group）,24 cases of mild brain injury（ mild brain injury group）,and 6 cases of severe brain injury（ severe brain injury group） were included in the study. Serum melatonin levels were measured by ELISA,then the melatonin levels between brain injury and control groups,mild and severe brain injury groups were compared.Sensitivity and specificity of melatonin for predicting brain damage in premature infants were analyzed using ROC curve.All premature infants were tested for NBNA at orthodontic gestational age of 40 weeks. Results Serum melatonin levels in brain injury group（72. 71 ± 8. 99 and 94. 5 ± 10. 07） pg/mL were significantly higher than those in control group（66. 42 ± 9. 34）pg/mL,P〈0. 05. Serum melatonin level in severe brain injury group（94. 50 ± 10. 07） pg/mL was significantly higher than that in mild brain injury group（72. 71 ± 8. 99） pg/mL,P〈0. 05. The AUC area of melatonin levels used to diagnose brain injury in premature infants was 0. 76 with a 95% confidence interval 0. 635-0. 886,an intercept value of 69. 5 pg/mL,a sensitivity of 86. 7%,and a specificity of 68. 4%（ P〈0. 05）. There was an adverse correlation between the serum melatonin level and NBNA score at orthodontic gestational age 40 weeks（ r =-0. 518,P〈0. 05）. Conclusion Serum melatonin level may have a certain value for the early prediction and severity assessment of brain injury in preterm infants.