血清NSE和S100B蛋白在新生儿高胆红素脑损伤的早期诊断及预后评估中的作用

Value of serum NSE and S100B proteins in early diagnosis and prognosis assessment of hyperbilirubinemia brain injury in neonates

目的分析血清神经元特异性烯醇化酶(neuron-specific enolase, NSE)和S100B蛋白对新生儿高胆红素血症脑损伤的早期诊断及预后评估的作用。方法以2018年7月至2020年1月蚌埠医学院第一附属医院收治的70例高胆红素血症合并脑损伤新生儿为观察组,选取同期30例无脑损伤的高胆红素血症患儿为对照Ⅰ组及30例健康足月新生儿为对照Ⅱ组。比较3组新生儿急性期血清总胆红素(total serum bilirubin, TSB)、NSE和S100B蛋白水平差异;并对观察组恢复期NSE和S100B蛋白水平复测,在出生28~30 d行新生儿行为神经测定(neonatal behavioral neurological assessment, NBNA)评分,观察不同预后新生儿NSE和S100B蛋白水平差异。结果观察组NSE和S100B水平均明显高于对照Ⅰ组、对照Ⅱ组(P<0.05),而对照Ⅰ组、对照Ⅱ组间比较差异无统计学意义(P>0.05)。观察组、对照Ⅰ组TSB水平显著高于对照Ⅱ组(P<0.05),观察组、对照Ⅰ组组间差异无统计学意义(P>0.05)。与急性期比较,观察组恢复期NSE、S100B蛋白、TSB水平明显下降(P<0.05),其中预后良好组NSE、S100B蛋白下降幅度明显大于预后不良组(P<0.05),但2组TSB水平比较差异无统计学意义(P>0.05)。结论血清NSE和S100B蛋白可作为胆红素脑损伤早期诊断的敏感指标,两者水平的变化和早期预后密切相关,对评估预后具有重要价值。

Objective To analyze the value of serum neuron⁃specific enolase(NSE)and S100B proteins in early diagnosis and prognosis assessment of hyperbilirubinemia brain injury in neonates.Methods 70 cases of neonatal hyperbilirubinemia brain inju⁃ry admitted into hospital from July 2018 to January 2020 were recruited as the observation group,and 30 cases of hyperbilirubinemia without brain injury and another 30 cases of healthy full⁃term newborns were designated as the control group I and II.The levels of ser⁃um total bilirubin(TSB),NSE and S100B proteins were compared between the 3 groups,and the levels of NSE and S100B protein of the observation group were retested during the recovery period.Neonatal behavioral neurological assessment(NBNA)was performed at day 28-30 after birth,and the levels of NSE and S100B in the neonates with different prognosis were observed in the process.Results The levels of NSE and S100B in the observation group were significantly higher than those in the control group I and II(P<0.05),but there were no significant differences when comparisons were made between the 2 control groups(P<0.05).The levels of TSB in the observation group and the control group I were significantly higher than that in the control group II(P<0.05),however there were no significant differences when comparisons were made between the observation group and control group I(P>0.05).Compared with the acute stage,the levels of NSE,S100B and TSB in the observation group significantly decreased(P<0.05).The amplitude of NSE and S100B decrease in the good prognosis group was significantly greater than that in the poor prognosis group(P<0.05).However,there were no significant differences in the TSB level,when comparisons were made between the 2 groups(P>0.05).Conclusion The serum NSE and S100B proteins can be used as sensitive indicators for early diagnosis of bilirubin brain injury.The changes of NSE and S100B proteins are closely related to early prognosis,and are of important value in prognosis evaluation.