血清S100B和髓鞘碱性蛋白与早产儿脑室周围白质软化的相关性研究

目的探讨脑白质损伤（PVL）早产儿血清S100B及髓鞘碱性蛋白（MBP）水平的变化及其与预后判定的关系。方法选择2010年7月1日至2012年12月31日于暨南大学附属顺德妇幼保健院新生儿科住院的出生胎龄〈34孕周的121例早产儿为研究对象,并根据头颅超声检查及MRI检查结果,将结果提示有PVL表现的78例早产儿纳入PVL组,将结果未见明显异常的43例早产儿纳入正常组。两组早产儿一般情况比较,差异无统计学意义（P〉0.05）。所有患儿出院后每3个月随访1次,并采用《Gesell量表》测定患儿运动及智力发育商直至患儿纠正胎龄达1岁。根据早产儿生后第7天的血清MBP（〉10.0μg/L）及S100B（〉4.5μg/L）水平,再将其分为1组（正常早产儿）、2组（血清S100B和MBP水平明显下降的PVL早产儿）及3组（血清MBP和S100B持续升高的PVL早产儿）。本研究遵循的程序符合暨南大学附属顺德妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书。结果 1PVL组早产儿血清S100B水平在生后第3天开始升高,至生后第7天达最高峰,均显著高于正常组早产儿,两组比较,差异有统计学意义（P〈0.05）;其血清S100B水平在生后第14天时降至最低,两组比较,差异无统计学意义（P〉0.05）。2PVL组早产儿血清MBP水平在生后第3天达到峰值,此后逐渐下降,且其生后第1,3,7,14天的血清MBP水平均显著高于正常组早产儿,两组比较,差异均有统计学意义（P〈0.05）。3随访结果显示,3组早产儿1岁时运动和智力发育商较1组和2组早产儿显著降低,前者与后二者比较,差异均有统计学意义（P〈0.05）。结论PVL患儿的血清MBP及S100B水平与其病情严重程度相关。患儿血清MBP及S100B水平持续升高超过7d,则提示其预后不良。

Correlation Study of Serum S100B and Myelin Basic Protein in Premature Infants With Periventricular Leukomalacia

Objective To investigate the changes of serum S100 Band myelin basic protein（MBP）in premature infants with periventricular leukomalacia（PVL）and their reliability in predicting outcome.Methods From 1st July 2010 to 31st December 2012,a total of 121 premature infants who were hospitalized in Maternal and Child Health Hospital,Jinan University were enrolled in the study.They were divided into PVL group（78 cases）and normal group（43 cases）according to their results of ultrasound and MRI.Serum MBP and S100 Blevels on the 1st day,3rd day,7th day and 14 th day after birth were detected.Developmental quotients（DQ）were measured using Gesell development schedules until their correted gestational age reached 1year old.They were also divided into group 1（normal premature infants）,group 2（PVL infants with decreased serum S100 Band MBP level）and group 3（PVL infants with increased serum S100 Band MBP level）according to their lab results at the 7th day after birth.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Maternal and Child Health Hospital of Jinan University.Informed consent was obtained from each participants′ parents.Results 1The serum S100 Bconcentration of infants in PVL group were obviously higher than those of normal group at the 1st day,3rd day,7th day after birth.And no significant difference was found at the14 th day after birth between two groups.2The serum MBP concentration of infants in PVL group were significantly higher than those of normal group at the 1st day,3rd day,7th day and 14 th day after birth.3Infants whose serum MBP and S100 Blevels increased at the 7th day after birth had poor outcomes.Conclusions The serum MBP and S100 Blevels are correlated with severity of central nervous system injury.The increases in serum S100 Band MBP at the 7th day after birth are associated with poor outcomes.