热性惊厥患儿外周血NF-κB、NSE的表达及相关因素分析

Expression and correlation of NF-κB and NSE in peripheral blood of children with fevered convulsion

目的分析热性惊厥患儿外周血核转录因子κB(nuclear factor kappa B,NF-κB)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)和乳酸水平变化以及各指标对患儿预后的预测价值。方法选取符合诊断的热性惊厥患儿100例,根据发作时间和频次等分为单纯组(SFS组)58例和复杂组(CFS组)42例,并选择同期发热无惊厥患儿50例为对照组。采用酶联免疫吸附测定法检测NF-κB、NSE的表达情况,并比较3组乳酸、血糖等指标水平。随访6个月,采用ROC曲线分析各指标预测患儿预后的价值。结果 SFS组和CFS组血清NF-κB、NSE、乳酸、血糖水平均较对照组升高,且CFS组NF-κB、NSE、乳酸和血糖又高于SFS组(P<0.05);惊厥发作次数≥2次者NF-κB、NSE、乳酸、血糖水平均高于惊厥发作次数<2次者(P<0.05);惊厥发作时间≥15 min者NF-κB、NSE、乳酸、血糖水平均高于惊厥发作时间<15 min者(P<0.05)。患儿惊厥发作次数和惊厥发作持续时间均与NF-κB、NSE、乳酸、血糖水平呈正相关(P<0.05)。ROC曲线分析显示,NSE、NF-κB、乳酸对惊厥患儿预后诊断的ROC曲线下面积分别为0.819、0.778、0.709,而三者联合ROC曲线下面积为0.838。随访6个月,复杂性热性惊厥患儿复发20例(47.6%)、转为癫痫10例(23.8%),发生率均高于单纯性热性惊厥患儿复发12例(20.7%)、转为癫痫3例(5.2%),其差异均有统计学意义(P<0.05)。结论热性惊厥患儿外周血NSE、NF-κB、乳酸、血糖水平均升高,且随着惊厥次数和持续时间而升高,NF-κB、NSE和乳酸联合检测对患儿预后有重要意义,值得临床推广应用。

Objective To analyze the changes of nuclear factor kappa B(NF-κB), neuron-specific enolase(NSE) and lactic acid levels in peripheral blood and the prognostic value of these indicators in children with fevered convulsion. Methods A total of 100 cases of children with fevered convulsion were selected as subjects. According to the time and frequency of onset, they were divided into simple group(SFS group) 58 cases and complex group(CFS group) 42 cases, and 50 cases without fevered convulsion in the same period were selected as the control group. The expression levels of transcription factor NF-κB and NSE were detected by elisa. All indexes were followed up for 6 months, and the prognosis of the children was predicted by ROC curve analysis. Results The levels of serum NF-κB, NSE, lactic acid and blood glucose in the SFS group and CFS group were higher than those in the control group(P<0.05). The levels of NF-κB, NSE, lactic acid and blood glucose were all higher than those of < 2 times. The levels of NF-κB, NSE, lactic acid and blood glucose were all higher than those of <15 min(P<0.05). The frequency and duration of convulsion were positively correlated with NF-κB, NSE level, lactic acid and blood glucose. According to the ROC curve analysis, the area under the curve of NSE, NF-κB and lactic acid for the prognosis of children with convulsion was 0.819, 0.778 and 0.709, respectively, while the area under the ROC curve of the three combined was 0.838. During the 6-month follow-up, 20 cases(47.6%) of the patients with complicated fevered convulsion relapsed, and 10 cases(23.8%) were converted to epilepsy. The incidence rate was higher than that of 12 cases(20.7%) and 3 cases(5.2%) of the patients with simple fevered convulsion relapsed, and the difference between the two groups was statistically significant(P<0.05). Conclusion The levels of NSE, NF-κB, lactic acid and blood glucose in peripheral blood of children with fever-induced convulsion were all increased, and increased with the frequency and duration of convulsion. The combined detection of NF-κB, NSE and lactic acid was of great significance for the prognosis of children with fever-induced convulsion and was worthy of clinical application.