脑瘫患儿血清神经元特异性烯醇化酶及髓鞘碱性蛋白浓度的变化及其临床意义

The detection and clinical significance of serum neuron-specific enolase and myelin basic protein in children with cerebral palsy

目的:探讨脑瘫患儿血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)和髓鞘碱性蛋白(myelin basic protein,MBP)水平的变化及其临床意义。方法:选取进行康复治疗的符合脑瘫诊断标准的脑瘫患儿46例(脑瘫组),同时选取性别、年龄与脑瘫组患儿匹配的健康儿童45名作为健康对照组。采用酶联免疫吸附试验(ELISA)法检测健康组儿童体检时及脑瘫组患儿治疗前、常规康复治疗3个月后的血清NSE和MBP浓度。采用脑瘫粗大运动功能分级系统(GMFCS)和粗大运动功能88项量表(GMFM-88)对脑瘫组患儿治疗前、后的粗大运动功能进行分级和评估。结果:健康组儿童血清NSE、MBP浓度分别为(6. 77±2. 08)μg/L、(0. 38±0. 10)μg/L;脑瘫组患儿治疗前血清NSE、MBP浓度分别为(16. 26±2. 94)μg/L、(1. 21±0. 41)μg/L,治疗3个月后浓度分别为(13. 56±2. 29)μg/L、(0. 85±0. 33)μg/L;脑瘫组患儿治疗前、后的GMFM-88评分分别为(132. 33±81. 60)分、(147. 07±83. 13)分。健康组儿童的NSE、MBP浓度与年龄之间均无显著相关性(P>0. 05),而脑瘫组患儿治疗前的NSE、MBP浓度与年龄之间均呈负相关(P <0. 05)。脑瘫组儿童治疗前的NSE、MBP浓度均明显高于健康组(均P <0. 05)。脑瘫组治疗前的NSE、MBP浓度与脑瘫粗大运动功能分级(GMFCS)之间均呈正相关(P <0. 05),与GMFM-88评分之间均呈负相关(P <0. 05)。脑瘫组治疗前、后组内NSE、MBP浓度、GMFM-88评分间的差异均具有统计学意义(P <0. 05)。结论:脑瘫患儿血清NSE和MBP浓度较健康儿童显著升高,随年龄增加而降低,且与脑瘫的障碍程度及粗大运动功能相关。

Objective:To investigate the changes and clinical significance of serum neuron-specific enolase(NSE)and myelin basic protein(MBP)in children with cerebral palsy.Methods:A total of 46 cases of children with cerebral palsy were selected as observation group,in the same period,45 cases of sex and age matched healthy children were selected as control group.The serum levels of NSE and MBP in the control group at the time of physical examination and in the observation group before and after 3 months of routine rehabilitation were detected by enzyme linked immunosorbent assay(ELISA).The cerebral palsy Gross Motor Function Classification System(GMFCS)and the Gross Motor Function Measure 88 item(GMFM-88)were used to grade and evaluate the gross motor function before and after treatment in the observation group.Results:The serum levels of NSE and MBP in the control group were(6.77±2.08)μg/L and(0.38±0.10)μg/L;the serum levels of NSE and MBP in the observation group before treatment were(16.26±2.94)μg/L and(1.21±0.41)μg/L respectively,and the serum levels of NSE and MBP in the observation group after 3 months of treatment were(13.56±2.29)μg/L and(0.85±0.33)μg/L respectively;the GMFM-88 scores of the observation group before and after treatment were(132.33±81.60)and(147.07±83.13)respectively.There was no significant correlation between NSE or MBP levels and age in healthy children of the control group(P >0.05),and there was a negative correlation between NSE or MBP levels and age before treatment in the observation group(P<0.05).There were significant differences in the levels of NSE or MBP between the control group and the observation group(P<0.05).There was a positive correlation between NSE or MBP levels of the observation group and GMFCS in children with cerebral palsy,and a negative correlation with GMFM-88 score(P<0.05).The differences of NSE,MBP and GMFM-88 scores in the observation group before and after treatment were statistically significant(P<0.05).Conclusion;Serum NSE and MBP levels in children with cerebral palsy were significantly higher than those in healthy children,and decreased with increasing of age,and correlated with the degree of cerebral palsy and gross motor function.