血清UCH-L1、HO-1联合aEEG在早产儿脑损伤早期诊断及预后评估中的价值

Application of serum UCH-L1 and HO-1 combined with AEEG for early diagnosis and prognosis of brain injury in preterm infants

目的探讨血清泛素羧基末端水解酶L1(UCH-L1)、血红素氧化酶-1(HO-1)联合振幅整合脑电图(aEEG)在早产儿脑损伤(BIPI)中早期诊断及预后评判的价值。方法选择2021年10月—2022年10月江苏省苏北人民医院收治的早产儿100例,根据颅脑核磁检查结果分为对照组(颅脑磁共振检查未见异常)40例,脑室旁-脑室内出血(PVH-IVH)组35例及脑白质损伤(WMD)组25例。PVH-IVH及WMD组早产儿根据纠正胎龄6个月的Gesell发育诊断量表中发育商(DQ)结果进一步分为预后良好组45例及预后不良组15例。检测3组早产儿出生后24 h、72 h的血清UCH-L1、HO-1水平。比较各组生后7 d及纠正胎龄40周时aEEG评分。采用ROC曲线分析UCH-L1、HO-1、aEEG评分在BIPI早期诊断及预后中的价值。结果血清UCH-L1及HO-1水平在生后24 h、72 h,PVH-IVH组及WMD组均高于对照组,且WMD组亦高于PVH-IVH组(P<0.05)。aEEG评分生后7 d及纠正胎龄40周PVH-IVH组及WMD组早产儿水平均明显低于对照组(P<0.05);WMD组、PVH-IVH组差异无统计学意义(P>0.05)。UCH-L1、HO-1、aEEG早期诊断BIPI的曲线下面积(AUC)分别为0.877、0.889、0.781,三者联合的AUC为0.929。预后不良组早产儿血清UCH-L1及HO-1水平在生后24 h、72 h均高于预后良好组(P<0.05)。生后7 d及纠正胎龄40周时,预后不良组早产儿aEEG评分水平明显低于预后良好组(P<0.05)。UCH-L1、HO-1、aEEG在评估BIPI患者预后的AUC分别为0.830、0.861、0.782,三者联合的AUC为0.953。结论BIPI早产儿UCH-L1、HO-1、aEEG评分明显呈异常表达状态,在早期诊断及评估预后方面具有一定价值。

Objective To evaluate the application of serum ubiquitin carboxyl terminal hydrolase L1(UCH-L1)and heme oxidase-1(HO-1)combined with amplitude integrated electroencephalogram(aEEG)for early diagnosis and prognosis of brain injury in preterm infants(BIPI).Methods A total of 100 preterm infants who were admitted to the neonatal intensive care unit(NICU),Northern Jiangsu People′s Hospital from October 2021 to October 2022 were selected.According to the results of brain magnetic resonance examination,the preterm infants were divided into three groups:a control group(without abnormal results of brain magnetic resonance examination,n=40),a periventricular intraventricular hemorrhage(PVH-IVH)group(n=35)and a brain white matter injury(WMD)group(n=25).According to the development quotient(DQ)of Gesell development diagnosis scale corrected for gestational age of six months,premature infants in the PVH-IVH and WMD groups were further divided into two groups:a good prognosis group(n=45)and a poor prognosis group(n=15).The levels of serum UCH-L1 and HO-1 in the three groups were measured 24 and 72 h after delivery.Their scores of aEEG were compared 7 days after delivery and at 40 weeks of corrected gestational age.A ROC curve was plotted to evaluate the value of UCH-L1,HO-1 and aEEG scores in the early diagnosis and prognosis of BIPI.Results The levels of serum UCH-L1 and HO-1 in the PVH-IVH group and the WMD group were higher than those in the control group at 24 h and 72 h after delivery,where the WMD group had higher serum UCH-L1 and HO-1 levels than the PVH-IVH group(P<0.05).The PVH-IVH group and the WMD group showed significantly lower aEEG scores than the control group 7 days after delivery and at 40 weeks of corrected gestational age(P<0.05),while there was no statistical difference in aEEG score between the WMD group and the PVH-IVH group(P>0.05).The AUCs of UCH-L1,HO-1 and aEEG for early diagnosis of BIPI were 0.877,0.889 and 0.781 respectively,whereas the AUC of UCH-L1 and HO-1 combined with aEEG was 0.929.The levels of serum UCH-L1 and HO-1 levels in the poor prognosis group were higher than those in the good prognosis group 24 h and 72 h after delivery(P<0.05).The poor prognosis group showed remarkably reduced aEEG score,compared with the good prognosis group 7 days after delivery and at 40 weeks of corrected gestational age(P<0.05).The AUCs of UCH-L1,HO-1 and AEEG for evaluating the prognosis of BIPI patients were 0.830,0.861 and 0.782,respectively,whereas the AUC of UCH-L1 and HO-1 combined with aEEG was 0.953.Conclusions Preterm infants with brain injury show abnormal levels of UCH-L1 and HO-1 and aEEG scores,with certain value for early diagnosis and evaluation of prognosis.