血清胶质纤维酸性蛋白和神经丝蛋白H磷酸化亚型对窒息早产儿脑损伤的诊断价值

Value of serum glial fibrillary acidic protein and phosphorylated neurofilament heavy subunit in diagnosis of brain injury in premature infants with asphyxia

目的分析血清胶质纤维酸性蛋白(GFAP)、神经丝蛋白H磷酸化亚型(pNF-H)对窒息早产儿脑损伤的诊断价值,为窒息早产儿脑损伤的诊断与神经发育预测提供理论依据。方法选择2021年5月—2022年5月南京医科大学附属泰州人民医院收治的窒息早产儿60例为研究对象,根据临床表现、头颅MRI、头颅B超及脑电图检查结果分为窒息脑损伤组29例,窒息无脑损伤组31例。采用酶联免疫吸附法(ELISA)检测早产儿生后1 d、3 d血清GFAP、pNF-H水平。采用Pearson法分析血清GFAP、pNF-H水平与新生儿行为神经测定(NBNA)评分、0~6岁儿童神经心理发育检查量表(DST)评分的相关性。采用受试者工作特征(ROC)曲线分析血清GFAP、pNF-H对窒息早产儿脑损伤的诊断价值。结果生后1 d、3 d,窒息脑损伤组血清GFAP水平分别为(8.67±2.46)ng/ml、(12.47±3.05)ng/ml,pNF-H水平分别为(273.87±30.57)pg/ml、(301.29±30.63)pg/ml。生后1 d、3 d,窒息无脑损伤组血清GFAP水平分别为(7.13±2.11)ng/ml、(8.22±2.19)ng/ml,pNF-H水平分别为(255.14±34.00)pg/ml、(264.63±33.93)pg/ml。窒息脑损伤组患儿生后1 d、3 d血清GFAP、pNF-H水平均高于窒息无脑损伤组(均P<0.05)。相关性分析结果显示:窒息脑损伤组早产儿血清GFAP、pNF-H水平与NBNA评分均呈负相关(r=-0.531、-0.486,均P<0.05),与DST评分也呈负相关(r=-0.519、-0.543,均P<0.05)。血清GFAP、pNF-H水平联合诊断窒息早产儿脑损伤的灵敏度为80.00%,特异度为87.10%,曲线下面积为0.892。结论窒息早产儿血清GFAP、pNF-H水平升高,与窒息后脑损伤有一定相关性,二者联合检测具有一定诊断及预测神经发育的价值。

Objective To analyze the value of serum glial fibrillary acidic protein(GFAP)and phosphorylated neurofilament heavy subunit(pNF-H)in diagnosis of brain injury in premature infants with asphyxia,so as to provide a theoretical basis for diagnosis of brain injury and prediction of neurological development in premature infants with asphyxia.Methods Sixty premature infants with asphyxia treated in Taizhou People's Hospital Affiliated to Nanjing Medical University from May 2021 to May 2022 were selected and divided into asphyxia brain injury group(29 cases)and asphyxia non-brain injury group(31 cases)according to their clinical manifestations,cranial MRI,Bultrasound and electroencephalogram.The levels of GFAP and pNF-H in serum of premature infants on the first day and the third day after birth were detected by enzyme-linked immunosorbent assay(ELISA).Pearson method was used to analyze the correlations between serum GFAP,pNF-H levels and neonatal behavioral neurological assessment(NBNA)score,and neuropsychological development examination scale for children aged 0-6 years(DST).The value of serum GFAP and pNF-H in diagnosis of brain injury in neonatal asphyxia was analyzed by receiver operating characteristic(ROC)curve.Results The serum levels of GFAP in asphyxia brain injury group at 1 and 3 days after birth were(8.67±2.46)ng/ml and(12.47±3.05)ng/ml,respectively,the serum levels of pNF-H in asphyxia brain injury group at 1 and 3 days after birth were(273.87±30.57)pg/ml and(301.29±30.63)pg/ml,respectively.The serum levels of GFAP in asphyxia non-brain injury group at 1 and 3 days after birth were(7.13±2.11)ng/ml and(8.22±2.19)ng/ml,respectively,the serum levels of pNF-H in asphyxia non-brain injury group at 1 and 3 days after birth were(255.14±34.00)pg/ml and(264.63±33.93)pg/ml,respectively.The serum levels of GFAP and pNF-H in asphyxia brain injury group at 1 and 3 days after birth were higher than those in asphyxia non-brain injury group(P<0.05).The results of correlation analysis showed that in asphyxia brain injury group,the levels of serum GFAP and pNF-H were negatively correlated with NBNA score(r=-0.531,-0.486,P<0.05)and DST score(r=0.519,-0.543,P<0.05).The sensitivity,specificity,and area under ROC curve of serum GFAP combined with pNF-H in diagnosis of brain injury in premature infants with asphyxia were 80.00%,87.10%,and 0.892,respectively.Conclusion The increase of serum GFAP and pNF-H levels in premature infants with asphyxia is related to brain injury after asphyxia,and the combined detection of serum GFAP and pNF-H has a certain value in diagnosis and prediction of neurological development in premature infants with asphyxia.