羊水污染与新生儿缺氧缺血性脑病以及血清Tau蛋白、S100B表达水平的相关研究

Study on the correlation between amniotic fluid contamination and neonatal hypoxicischemic encephalopathy and the expression levels of serum Tau protein and S100B

目的探讨羊水污染与新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)以及血清Tau蛋白、Sl00B表达水平的相关性。方法将2018年8月至2022年8月邯郸市妇幼保健院新生儿科重症监护室(neonatal intensive care unit,NICU)收治的75例中度和重度HIE患儿纳入HIE组(中度31例,重度44例),选择同期在产科出生的正常健康足月新生儿35例纳入对照组。根据羊水污染程度,将患儿分为羊水正常组以及Ⅰ度、Ⅱ度、Ⅲ度羊水污染组。比较各组羊水污染情况以及血清Tau蛋白、S100B表达水平。统计学方法采用t检验、Student-Newman-Keuls检验、χ^(2)检验或Fisher确切概率法。结果HIE组母亲自然阴道分娩的比例低于对照组[36.0%(27/75与57.1%(20/35)],HIE组新生儿5 min Apgar评分低于对照组[(3.5±1.4)与(8.5±1.0)分],差异均有统计学意义(P值均<0.05)。75例HIE患儿中,羊水正常20例(26.7%),Ⅰ度羊水污染13例(17.3%),Ⅱ度羊水污染10例(13.3%),Ⅲ度羊水污染32例(42.7%)。重度HIE患儿Ⅲ度羊水污染的比例高于中度HIE患儿,差异有统计学意义[59.1%(26/44)与19.4%(6/31),P<0.05]。中、重度HIE组患儿血清Tau蛋白、S100B水平明显高于对照组(P值均<0.05);重度HIE组患儿血清Tau蛋白、S100B水平明显高于中度HIE组,差异均有统计学意义(P值均<0.05)。羊水正常和Ⅰ度、Ⅱ度、Ⅲ度羊水污染组的HIE患儿血清Tau蛋白、S100B水平均明显高于对照组,差异均有统计学意义(P值均<0.05);Ⅲ度羊水污染HIE组患儿血清Tau蛋白、S100B水平明显高于羊水正常HIE组和Ⅰ度羊水污染HIE组患儿,差异均有统计学意义(P值均<0.05)。结论羊水污染与新生儿HIE有密切关系,重度HIE患儿中,Ⅲ度羊水污染的比例较高,血清Tau蛋白、S100B水平也较高,脑损伤程度较严重。

Objective To investigate the correlation between amniotic fluid contamination and neonatal hypoxic-ischemic encephalopathy(HIE)and the expression levels of serum Tau protein and Sl00B.Method A total of 75 neonates with moderate to severe HIE admitted to the Neonatal Intensive Care Unit(NICU),Handan Maternal and Child Health Care Hospital from August 2018 to August 2022 were included in the HIE group(31 cases of moderate and 44 cases of severe).A total of 35 normal healthy full-term newborns born in the Department of Obstetrics at the same period were included in the control group.According to the degree of amniotic fluid contamination,the children were divided into normal amniotic group and amniotic fluid contamination group ofⅠ,ⅡandⅢdegrees.Amniotic fluid contamination and serum Tau protein and S100B expression levels were compared among all groups.The statistical methods performed by t-test,Student-Newman-Keuls test,χ^(2) test or Fisher exact probability method.Result The proportion of natural vaginal delivery in the HIE group was lower than that in the control group[36.0%(27/75)vs 57.1%(20/35)],and the 5 min Apgar score of neonates in the HIE group was lower than that in the control group[(3.5±1.4)vs(8.5±1.0)points],with statistical significance(all P<0.05).Of the 75 HIE infants,20 cases(26.7%)had normal amniotic fluid,13 cases(17.3%)had grade I amniotic fluid contamination,10 cases(13.3%)had gradeⅡamniotic fluid contamination,and 32 cases(42.7%)had gradeⅢamniotic fluid contamination.The proportion of gradeⅢamniotic fluid contamination in children with severe HIE was higher than that in children with moderate HIE,and the difference was statistically significant[59.1%(26/44)vs 19.4%(6/31),P<0.05].The levels of serum Tau protein and S100B in moderate and severe HIE groups were significantly higher than those in the control group(P<0.05).The levels of serum Tau protein and S100B in severe HIE group were significantly higher than those in moderate HIE group,and the differences were statistically significant(all P<0.05).The levels of serum Tau protein and S100B in HIE group with normal amniotic fluid and amniotic fluid contamination inⅠ,ⅡandⅢdegrees were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of serum Tau protein and S100B in gradeⅢamniotic fluid contaminated HIE group were significantly higher than those in normal amniotic fluid HIE group and gradeⅠamniotic fluid contaminated HIE group,and the differences were statistically significant(all P<0.05).Conclusion Amniotic fluid contamination is closely related to neonates with HIE.Among children with severe HIE,the proportion of gradeⅢamniotic fluid contamination is higher,the levels of serum Tau protein and S100B are also higher,and the degree of brain injury is more serious.