血清标志物在早产儿出血性脑损伤中的临床意义

Clinical Significance of Serum Markers for Hemorrhagic Brain Injury in Preterm Infants

目的:探讨血清促红细胞生成素(EPO)、神经元特异性烯醇化酶(NSE)、中枢神经特异蛋白(S100B)、髓鞘碱性蛋白(MBP)与早产儿出血性脑损伤的关系。方法:选择2014年10月至2015年9月深圳市第二人民医院、深圳市妇幼保健院、深圳市人民医院和深圳市龙华区人民医院新生儿科收治的胎龄28~34周早产儿为研究对象,根据头颅B超和头颅磁共振成像(MRI)结果分为出血性脑损伤和无脑损伤组,采用酶联免疫吸附试验法(ELISA)测定血清EPO、NSE、S100B、MBP浓度,比较两组血清EPO、NSE、S100B蛋白及MBP的水平,分析早产儿出血性脑损伤的影响因素。结果:出血性脑损伤组早产儿的血清EPO水平低于无脑损伤组,血清NSE、S100B、MBP水平高于无脑损伤组,差异有统计学意义(P<0.05)。出血性脑损伤组早产儿的血小板计数、收缩压均低于无脑损伤组,差异具有统计学意义(P<0.05)。多因素logistic回归分析发现,血清高浓度EPO、收缩压及血小板计数升高是出血性脑损伤的保护因素,而高浓度NSE和S100B蛋白及男性患儿是出血性脑损伤的危险因素。结论:血清EPO、NSE、S100B、MBP水平与早产儿出血性脑损伤密切相关,同时临床中需加强对男性早产儿血小板计数的监测及血压的管理。

Objective To investigate the relationship between serum erythropoietin(EPO),neuron specific enolase(NSE),S100 calciu binding protein B(S100B),myelin basic protein(MBP)and hemorrhagic brain injury in premature infants.Methods Preterm infants aged 28 to 34 weeks admitted to the Second People's Hospital of Shenzhen,Shenzhen Maternal and Child Health Hospital,Shenzhen People's Hospital and Shenzhen Longhua District People's Hospital from October 2014 to September 2015 were prospectively selected as subjects.According to the results of head ultrasound and head magnetic resonance imaging(MRI),they were divided into hemorrhagic brain injury group and nonbrain injury group.Serum concentrations of EPO,NSE,S100B and MBP were determined by enzyme-related immunosorbent assay(ELISA).The levels of serum EPO,NSE,S100B protein and MBP were compared between the two groups,and the relationship between the levels and hemorrhagic brain injury of premature infants was analyzed.Results The level of serum EPO in hemorrhagic brain injury group was lower than that in no brain injury group,and the levels serum NSE,S100B and MBP were higher than those in no brain injury group,the differences were statistically significant(P<0.05).Systolic blood pressure and platelet count in hemorrhagic brain injury group were lower than those in no brain injury group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that high concentrations of serum EPO,systolic blood pressure,and platelet count are protective factors for hemorrhagic brain injury,while high concentrations of NSE and S100B protein and male children are risk factors for hemorrhagic brain injury.Conclusion The levels of serum EPO,NSE,S100B and MBP are closely related to hemorrhagic brain injury in premature infants.At the same time,it is necessary to strengthen the monitoring of platelet count and blood pressure management in male premature infants in clinical practice.