S100B联合神经元特异性烯醇化酶及血乳酸对重度新生儿缺氧缺血性脑病的预测价值

The predictive value of S100B combined with neuron specific enolase and serum lactate for severe neonatal hypoxic ischemic encephalopathy

目的探讨中枢神经系统特异性蛋白B(central nervous system specific protein B,S100B)联合神经元特异性烯醇化酶(neuron specific enolase,NSE)及血乳酸对重度新生儿缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)的预测价值。方法采用回顾性研究方法,选择2019年4月至2022年4月因围生期窒息入住西安交通大学附属儿童医院重症医学科的126例患儿为研究对象,临床确诊HIE的患儿为观察组(45例),非HIE患儿为对照组(81例)。比较两组各指标的差异;对可能引起重度HIE的指标行单因素Logistic回归分析后进行多因素Logistic回归;将危险因素带入受试者操作特征曲线(receiver operating characteristic curve,ROC),分析其对预后的预测价值。结果两组在胎龄、体重、性别等方面差异无统计学意义(P均>0.05)。观察组Apgar评分低于对照组;心肺复苏、机械通气、产程延长发生率高于对照组,差异具有统计学意义(P均<0.05)。与对照组比较,观察组脑电图及头部核磁共振成像异常比率、乳酸浓度(t=3.19)、S100B(8 h及72 h t值分别为13.10、2.00)及NSE(8 h及72 h t值分别为10.85、15.57)均增高,差异具有统计学意义(P均<0.05)。将可能引起重度HIE的指标进行二元logistic回归分析发现,5 min、10 min Apgar评分与重度HIE的发生风险呈负相关(OR<1且P<0.05);产程延长、心肺复苏、机械通气、生后8 h S100B浓度和8 h NSE浓度及乳酸等是重度HIE的危险因素(OR>1且P<0.05)。生化指标S100B、NSE及乳酸三者对重度HIE的预测临界值是1.87μg/L、19μg/L、4.6 mmol/L,预测灵敏度78%、68%和75%,特异度66%、71%和67%,曲线下面积均大于0.5。三者联合预测灵敏度为87%,特异度79%,曲线下面积0.86(P<0.05)。结论S100B、NSE及血乳酸是新生儿重度HIE的独立危险因素,三者联合应用可提高预测价值。

Objective To investigate the predictive value of central nervous system specific protein B(S100B)combined with neuron specific enolase(NSE)and serum lactate for severe neonatal hypoxic ischemic encephalopathy(HIE)induced by perinatal asphyxia.Methods A retrospective study was conducted.A total of 126 neonates admitted to the Intensive Care Unit of Children′s Hospital Affiliated to Xi′an Jiaotong University due to perinatal asphyxia from April 2019 to April 2022 were selected as the research subjects.Neonates who were clinically diagnosed with HIE were selected as the observation group(45 cases),and those without HIE were selected as the control group(81 cases).The differences of each parameter between the two groups were compared.Univariate and multivariate Logistic regression were used to analyze the indicators that might cause severe HIE.The risk factors were put into the receiver operating characteristic curve(ROC)to analyze their predictive value for prognosis.Results There were no significant differences in gestational age,weight and gender between the two groups(all P>0.05).The Apgar scores in the observation group were lower than those in the control group;the rates of cardiopulmonary resuscitation,mechanical ventilation,and prolonged labor were higher than those in the control group.These differences are statistically significant(all P<0.05).Compared with the control group,the observation group showed significantly higher rates of abnormal brain electroencephalogram and cranial magnetic resonance imaging,as well as increased levels of lactate,S100B(t-values for 8 h and 72 h were 13.10 and 2.00 respectively),and NSE(t-values for 8 h and 72 h were 10.85 and 15.57 respectively),all with statistical significance(all P<0.05).By conducting binary Logistic regression analysis on indicators that might cause HIE,it was found that Apgar scores at 5 minutes and 10 minutes were negatively correlated with the risk of severe HIE(OR<1 and P<0.05).Prolonged labor,as well as factors such as cardiopulmonary resuscitation,mechanical ventilation,S100B concentration at 8 hours after birth,NSE concentration at 8 hours after birth,and lactate levels were all risk factors for poor prognosis(OR>1 and P<0.05).The predictive threshold values for severe HIE using the biochemical markers S100B,NSE,and lactate were 1.87μg/L,19μg/L,and 4.6 mmol/L respectively.The sensitivity of prediction were 78%,68%,and 75%respectively;while the specificity were 66%,71%,and 67%,and all area under the curve(AUC)was greater than 0.5.The sensitivity of the combined prediction by the three factors was 87%,with a specificity of 79%and AUC 0.86(P<0.05).Conclusion S100B,NSE and serum lactate are independent risk factors for predicting neonatal serve HIE,and the combination of the three indicators can improve the predictive efficiency.