缺氧缺血性脑病新生儿亚低温治疗效果影响因素及与改良aEEG评分和血清HMGB1、sICAM-1关系

Influencing Factors of the Effect of Mild Hypothermia Treatment in Neonates with Hypoxic-ischemic Encephalopathy and Its Relationship with Modified aEEG Score, Serum HMGB1 and sICAM-1

目的 探讨缺氧缺血性脑病新生儿亚低温治疗效果影响因素及与改良振幅整合脑电图(aEEG)评分和血清高迁移率族蛋白B1(HMGB1)、可溶性细胞间黏附分子1(sICAM-1)关系。方法 选取2022年8月—2023年8月收治的行亚低温治疗缺氧缺血性脑病新生儿95例,根据治疗后临床效果分为显效组(31例)、有效组(50例)和无效组(14例)3组,比较3组临床资料及缺氧缺血性脑病新生儿亚低温治疗前后改良aEEG评分和血清HMGB1、sICAM-1,探讨缺氧缺血性脑病新生儿亚低温治疗效果影响因素,分析改良aEEG评分和血清HMGB1、sICAM-1与缺氧缺血性脑病新生儿治疗效果关系及对其预测价值。结果 无效组新生儿神经元特异性烯醇化酶(NSE)、C反应蛋白(CRP)、乳酸和血清HMGB1、sICAM-1高于显效组和有效组,改良aEEG评分低于显效组和有效组;有效组新生儿NSE、CRP、乳酸和血清HMGB1、sICAM-1高于显效组,改良aEEG评分低于显效组(P<0.05)。NSE、CRP、乳酸、改良aEEG评分和血清HMGB1、sICAM-1为影响缺氧缺血性脑病新生儿亚低温治疗效果的危险因素(P<0.01,P<0.05)。与治疗前比较,治疗后亚低温缺氧缺血性脑病新生儿改良aEEG评分升高,血清HMGB1和sICAM-1降低(P<0.01)。改良aEEG评分与缺氧缺血性脑病新生儿亚低温治疗效果呈正相关,血清HMGB1和sICAM-1与缺氧缺血性脑病新生儿亚低温治疗效果呈负相关(P<0.01)。改良aEEG评分和血清HMGB1、sICAM-1单项预测缺氧缺血性脑病新生儿亚低温治疗效果的曲线下面积、敏感度、准确度低于三项联合(P<0.05)。结论 缺氧缺血性脑病新生儿亚低温治疗后改良aEEG评分升高,血清HMGB1和sICAM-1降低,且与治疗效果相关,三项联合检测对治疗效果有较高预测价值。

Objective To investigate the influencing factors of mild hypothermia treatment in neonates with hypoxic-ischemic encephalopathy(HIE)and its relationship with modified amplitude integrated electroencephalogram(aEEG)score,serum high mobility group protein B1(HMGB1)and soluble intercellular adhesion molecule 1(sICAM-1).Methods A total of 95 neonates with HIE undergoing mild hypothermia treatment from August 2022 to August 2023 were selected,and divided into three groups according to the clinical effect after treatment:significantly effective group(n=31),effective group(n=50)and ineffective group(n=14).Clinical data,the modified aEEG score and serum HMGB1 and sICAM-1 were compared before and after mild hypothermia treatment in newborns with HIE among the three groups.The influencing factors of mild hypothermia treatment effect in neonates with HIE were explored,and the relationship between modified aEEG score,serum HMGB1 and sICAM-1 and the therapeutic effect in neonates with HIE and its predictive value were analyzed.Results Neuron specific enolase(NSE),C reactive protein(CRP),lactic acid,serum HMGB1 and sICAM-1 in the ineffective group were higher than those in the significantly effective and effective groups,while the modified aEEG score was lower than that in the significantly effective and effective groups(P<0.05).NSE,CRP,lactic acid,modified aEEG score,serum HMGB1 and sICAM-1 were the risk factors affecting the therapeutic effect of mild hypothermia treatment in neonates with HIE(P<0.01,P<0.05).Compared with that before treatment,the modified aEEG score of neonates with HIE undergoing mild hypothermia treatment was increased after treatment,while serum HMGB1 and sICAM-1 were decreased(P<0.01).Compared with the significantly effective group,the modified aEEG scores of the effective and ineffective groups were lower,while serum HMGB1 and sICAM-1 were increased.Compared with the effective group,the modified aEEG score of the ineffective group was lower,while serum HMGB1 and sICAM-1 were increased(P<0.05).The modified aEEG score was positively correlated with the effect of mild hypothermia treatment in neonates with HIE,whereas the serum HMGB1 and sICAM-1 were negatively correlated with the effect of mild hypothermia treatment in neonates with HIE(P<0.01).The effect of the modified aEEG score,serum HMGB1 and sICAM-1 alone in predicting the effect of mild hypothermia treatment in neonates with HIE was lower than that of three indicators in combination(P<0.05).Conclusion The modified aEEG score was increased while serum HMGB1 and sICAM-1 was decreased after mild hypothermia treatment in neonates with HIE,and the combined detection of the three has high predictive value for the therapeutic effect.