泛素羧基末端水解酶L1、胶质纤维酸性蛋白水平对新生儿窒息脑损伤的诊断价值

The diagnostic values of levels of serum UCH-L1 and GFAP for brain injury after neonatal asphyxia

目的探究血清泛素羧基末端水解酶L1(UCH-L1)、胶质纤维酸性蛋白(GFAP)水平对新生儿窒息后脑损伤的诊断价值。方法选取2016年1月至2019年5月海口市第四人民医院收治的窒息新生儿126例,根据1 minApgar评分分为重度窒息组57例和轻度窒息组69例。另根据病儿出生后5~14 d颅脑B超、CT或核磁共振扫描结果,将入组病儿分为脑损伤组(77例)和无脑损伤组(49例)。另选取同期在海口市第四人民医院出生的健康新生儿123例为对照组。采用酶联免疫吸附(ELISA)法测定所有受试新生儿血清UCH-L 1、GFAP水平,Pearson法进行相关性分析,ROC曲线进行血清UCH-L 1、GFAP诊断价值分析。结果重度窒息组新生儿神经行为评估(NBNA)评分明显低于轻度窒息组[(32.05±1.79)分比(36.12±2.54)分,P<0.05]。对照组、轻度窒息组、重度窒息组血清UCH-L 1[(0.78±0.25)ng/mL、(1.36±0.42)ng/mL、(2.19±0.71)ng/mL]、GFAP[(0.48±0.16)ng/mL、(1.14±0.28)ng/mL、(1.65±0.49)ng/mL]水平依次显著升高(P<0.05),1 minApgar评分依次显著降低[(9.14±1.09)、(5.46±1.28)、(2.25±0.73),P<0.05]。脑损伤组病儿血清UCH-L 1、GFAP水平明显高于无脑损伤组病儿(P<0.05),NBNA评分明显低于无脑损伤组病儿(P<0.05)。窒息后脑损伤病儿血清UCH-L 1、GFAP水平均与NBNA评分呈负相关(P<0.05)。低1minApgar评分、低NBNA评分、高UCH-L 1水平、高GFAP水平是影响新生儿窒息后脑损伤发生的独立危险因素(P<0.05)。血清UCH-L 1、GFAP联合预测新生儿窒息后脑损伤的曲线下面积为0.876,灵敏度为89.60%,特异度为88.00%。结论新生儿窒息后脑损伤病儿血清UCH-L 1、GFAP水平显著升高,可能作为生物标志物,对新生儿窒息后脑损伤有一定诊断价值。

Objective To explore the diagnostic values of serum ubiquitin carboxy terminal hydrolase L 1(UCH-L 1)and glial fibrillary acidic protein(GFAP)levels on brain injury after neonatal asphyxia.Methods One hundred and twenty-six cases of asphyxia neonatorum in Haikou Fourth People's Hospital from January 2016 to may 2019 were selected and assigned into severe asphyxia group(57 cases)and mild asphyxia group(69 cases).According to the results of brain B-ultrasound,CT or MRI scan from 5 to 14 days after birth,the children were divided into brain injury group(77 cases)and non brain injury group(49 cases).Another 123 healthy newborns born in Haikou Fourth People's Hospital in the same period were selected as the control group.The levels of serum UCH-L 1 and GFAP were measured by enzyme-linked immunosorbent assay(ELISA),Pearson method was used for correlation analysis,and ROC curve was used to analyze the diagnostic values of serum UCH-L 1 and GFAP.Results The score of Neonatal Behavioral Neurological Assessment(NBNA)in severe asphyxia group was significantly lower than that in mild asphyxia group[(32.05±1.79)scores vs.(36.12±2.54)scores,P<0.05].The levels of serum UCH-L 1[(0.78±0.25)ng/mL,(1.36±0.42)ng/mL,(2.19±0.71)ng/mL]and GFAP[(0.48±0.16)ng/mL,(1.14±0.28)ng/mL,(1.65±0.49)ng/mL]in the control group,mild asphyxia group and severe asphyxia group were increased signifi⁃cantly in turn(P<0.05),and 1 min Apgar score was decreased significantly in turn[(9.14±1.09),(5.46±1.28),(2.25±0.73),P<0.05].The levels of serum UCH-L 1 and GFAP in the brain injury group were significantly higher than those in the non brain injury group(P<0.05),and the score of NBNA was significantly lower than that in the non brain injury group(P<0.05).The levels of serum UCH-L 1 and GFAP in neonatal asphyxia with brain injury were negatively correlated with NBNA score(P<0.05).Low 1 min Apgar score,low NBNA score,high UCH-L 1 level and high GFAP level were independent risk factors for brain injury after neonatal asphyxia(P<0.05).The area under the curve of the combined prediction of serum UCH-L 1 and GFAP was 0.876,the sensitivity was 89.60%,and the specificity was 88.00%.Conclusion The levels of serum UCH-L 1 and GFAP are significantly increased in neonatal asphyxia with brain injury,which may be used as a biomarker for the diagnosis of brain injury after neonatal asphyxia.