血清HMGB1、GFAP、UCH-L1对窒息早产儿脑损伤的诊断价值

Diagnostic value of serum HMGB1,GFAP,and UCH-L1 for brain injury in asphyxia premature infants

目的检测窒息脑损伤早产儿血清高迁移率族蛋白1(HMGB1)、胶质纤维酸性蛋白(GFAP)、泛素羧基末端水解酶L1(UCH-L1)的水平,并分析其对窒息早产儿脑损伤的诊断价值。方法选取2018年1月至2020年4月在该院住院的单纯窒息早产儿96例,其中有脑损伤早产儿46例(研究组),无脑损伤早产儿50例(对照组)。采用酶联免疫吸附试验(ELISA)检测两组患儿血清HMGB1、GFAP、UCH-L1水平,采用振幅整合脑电图(aEEG)监测脑功能,采用20项行为神经测定方法(NBNA)对患儿神经行为进行评分,利用智能发育量表(CDCC)评估神经运动及智能发育情况。结果研究组患儿血清HMGB1、GFAP、UCH-L1水平及aEEG评分显著高于对照组,NBNA、智力发育指数(MDI)、运动发育指数(PDI)评分显著低于对照组,差异均有统计学意义(P<0.05);Pearson相关分析显示,脑损伤窒息早产儿血清HMGB1、GFAP、UCH-L1均与aEEG评分呈正相关(P<0.05),与NBNA、MDI、PDI评分呈负相关(P<0.05);受试者工作特征(ROC)曲线分析显示,血清HMGB1、GFAP、UCH-L1水平单独诊断窒息早产儿脑损伤的曲线下面积分别为0.860、0.781、0.773,敏感度分别为71.70%、69.30%、68.70%,特异性分别为92.00%、89.00%、91.30%,三者联合诊断的曲线下面积为0.981,敏感度为97.80%,特异度为96.00%。结论脑损伤窒息早产儿血清HMGB1、GFAP、UCH-L1水平升高,三者联合检测对窒息早产儿脑损伤具有一定诊断价值。

Objective To detect the levels of serum high mobility group box 1(HMGB1),glial fibrillary acidic protein(GFAP),ubiquitin carboxyl terminal hydrolase L1(UCH-L1)in asphyxia premature infants with brain injury,and to analyze their diagnostic value for brain injury in asphyxia premature infants.Methods From January 2018 to April 2020,96 premature infants with simple asphyxia hospitalized in the hospital were selected,including 46 premature infants with brain injury(study group)and 50 premature infants without brain injury(control group),enzyme linked immunosorbent assay(ELISA)was used to detect the levels of serum HMGB1,GFAP and UCH-L1,amplitude integration electroencephalogram(aEEG)was used to monitor brain function;20 Neonatal Behavioral Neurological Assessment(NBNA)were used to assess the neurobehavioral status of the children;the CDCC Infant Intelligence Development Test Manual(CDCC)was used to evaluate neural motor and intelligence development.Results The levels of serum HMGB1,GFAP and UCH-L1 in the study group were significantly higher than those in the control group(P<0.05);the aEEG graphic correction scores in the study group were significantly higher than those in the control group(P<0.05);the NBNA score in the study group was significantly lower than that in the control group(P<0.05);the scores of MDI and PDI in the study group were significantly lower than those in the control group(P<0.05);Pearson test results showed that serum HMGB1,GFAP,UCH-L1 in asphyxiated preterm infants with brain injury were positively correlated with aEEG score(P<0.05),and negatively correlated with NBNA,MDI,PDI scores(P<0.05);ROC curve analysis showed that the area under the curve of serum HMGB1,GFAP and UCH-L1 levels in the diagnosis of asphyxiated preterm infants with brain injury was 0.860,0.781 and 0.773 respectively,the sensitivity was 71.70%,69.30%,68.70%,and the specificity was 92.00%,89.00%and 91.30%,respectively;the area under the curve of combined diagnosis of HMGB1,GFAP and UCH-L1 was 0.981,the sensitivity was 97.80%,and the specificity was 96.00%.Conclusion The levels of serum HMGB1,GFAP,and UCH-L1 are increased in asphyxia preterm infants with cerebral injury,the combined detection of three is of certain diagnostic value for cerebral injury in asphyxia preterm infants.