pNF-H、MMP-9联合aEEG对早产儿脑损伤的早期预测价值

The value of pNF-H,MMP-9 and aEEG in early prediction of brain injury among premature infants

目的评价神经丝蛋白H磷酸化亚型(pNF-H)、基质金属蛋白酶-9(MMP-9)联合振幅整合脑电图(aEEG)对早产儿脑损伤的早期预测价值。方法选择2018年9月至2019年12月收入徐州医科大学附属医院新生儿重症监护室的具有高风险脑损伤的早产儿为研究对象,根据头颅影像学结果,将56例早产儿分为脑损伤组26例和无脑损伤组30例。两组早产儿均于生后6 h进行aEEG检查,并采用酶联免疫吸附法(ELISA法)检测早产儿生后1 d、3 d、7 d血浆中pNF-H、MMP-9水平。以生后第3天血浆pNF-H、MMP-9水平、aEEG结果及三者联合得到的总体预测概率变量为自变量,疾病诊断结果为因变量,绘制ROC曲线,计算灵敏度、特异度及曲线下面积(AUC)。结果脑损伤组早产儿生后1 d、3 d、7 d血浆pNF-H和MMP-9水平较无脑损伤组显著升高,差异均有统计学意义,且脑损伤组血浆pNF-H、MMP-9水平在生后3 d时检测浓度最高。脑损伤组与无脑损伤组中aEEG异常的比例差异有统计学意义。三者联合诊断的曲线下面积(AUC)显著大于单独检测pNF-H、MMP-9水平及aEEG,诊断的灵敏度达到96.2%,特异度达到90.0%。结论pNF-H、MMP-9联合aEEG诊断对早产儿脑损伤具有早期预测价值。

Objective To evaluate the value of phosphorylated neurofilament heavy subunit(pNF-H),matrix metallo proteinase-9(MMP-9)and amplitude integrated electr-oencephalography(aEEG)in early prediction of brain injury in premature infants.MethodsA total of 56 premature infants with high-risk of brain injury admitted to the neonatal intensive care unit of affiliated hospital of Xuzhou Medical University from September 2018 to December 2019 were selected.Two groups included brain injury group(26 cases)and non-brain injury group(30 cases)were divided according to results of cranial imaging.aEEG examination was performed at 6 hours after birth in both groups,and concentration of pNF-H and MMP-9 in plasma were detected by enzyme-linked immunosorbent assay(ELISA)at 1,3 and 7 days after birth.The ROC curve was drawn based on using concentration of pNF-H,MMP-9 and aEEG results at 3rd day postnatal,as well as their combined predictive probability as independent variables and brain injury or not as dependent variables,and the sensitivity,specificity and area under the curve(AUC)were calculated.ResultsThe plasma concentration of pNF-H and MMP-9 in the brain injury group were significantly higher on 1st day,3rd day and 7th day after birth than those in the non-brain injury group.And the plasma pNF-H and MMP-9 in brain injury group were the highest on 3rd day after birth.There was significant difference in the proportion of abnormal aEEG between the brain injury group and the non-brain injury group.The area under the curve(AUC)of the combined diagnosis was significantly higher than that of the single detection of pNF-H,MMP-9 and Aeeg.The sensitivity and specificity of combined diagnosis was 96.2%and 90%respectively.ConclusionThere was early predictive value using combined diagnosis of pNF-H,MMP-9 and aEEG for brain injury among premature infants.