窒息新生儿脑干听觉诱发电位与血清神经元特异性烯醇化酶的相关性分析

目的：通过研究窒息患儿脑干听觉诱发电位（BAEP）异常与神经元特异性烯醇化酶（NSE）的相关性，探讨NSE对早期了解窒息患儿听神经损害的临床意义和应用前景。方法：选择该院窒息足月新生儿52例作为研究组，根据Apgar评分以及是否合并缺氧缺血性脑病(HIE)分为单纯轻度窒息组23例、单纯重度窒息组15例和窒息合并HIE组14例。采用双盲试验在生后7 d同一时间检测BAEP和NSE，初次BAEP检测异常者在生后3个月同一时间进行第2次BAEP和NSE检测。正常足月新生儿30例作为对照组。结果：窒息患儿两次听力损伤检出率分别为50.0%，21.2%。BAEP两次检出异常率，重度窒息组(63.3%，26.3%)与轻度窒息组(36.9%，5.9%)比较，差异均有显著性意义(P<0.05)，HIE组(57.1%，31.3%)与重度窒息组比较差异无显著性意义。各研究组NSE水平均明显高于对照组(P<0.01)，重度窒息组为26.70±2.34 μg/L明显高于轻度窒息组的17.18±3.16 μg/L，差异有显著性意义(P<0.01)，HIE组为27.00±2.01 μg/L，与重度窒息组比较差异无显著性意义。BAEP异常组NSE水平为25.69±4.12 μg/L高于BAEP正常组的17.15±3.09 μg/L(P<0.01)，NSE水平随着V波反应阈值的增高而增高(P<0.05)。结论：血清NSE水平与BAEP密切相关，可作为早期评估窒息患儿听神经损害和判断预后的指标之一。

Relationship between brainstem auditory evoked potential and serum neuron-specific enolase in neonates with asphyxia

OBJECTIVE: To study the correlation between brainstem auditory evoked potential (BAEP) and serum neuron-specific enolase (NSE) in neonates with asphyxia and explore the role of NSE in the evaluation of hearing impairment following asphyxia. METHODS: Fifty-two term neonates with asphyxia, including 38 cases of simple asphyxia (mild: 23 cases; severe: 15 cases) and 14 cases of asphyxia complicated by hypoxic-ischemic encephalopathy (HIE), were enrolled. In the double-blind trial, BAEP and NSE were simultaneously detected 7 days after birth. The patients who did not pass BAEP test received another BAEP and NSE examinations 3 months after birth. Thirty healthy term neonates served as normal control group. RESULTS: Of the 52 neonates with asphyxia, 50.0% and 21.2% of patients failed the initial and the second BAEP tests, respectively. The detection rates of BAEP anomalies in the simple severe asphyxia group in the initial and the second tests (63.3% and 26.3%, respectively) were significantly higher than those in the simple mild asphyxia group (36.9% and 5.9%, respectively)(P<0.05). The neonates with asphyxia complicated by HIE showed a higher detection rate of BAEP anomalies in the second test compared with the asphyxiated neonates without HIE (31.3% vs 16.7%; P<0.05). Mean serum NSE levels in asphyxiated neonates were significantly higher than those in normal controls (P<0.01). There were significant differences in serum NSE levels between the neonates with mild and severe asphyxia (26.70±2.34 μg/L vs 17.18±3.16 μg/L;P<0.01). The asphyxiated neonates with HIE had serum NSE levels similar to the simple severely asphyxiated neonates. Serum NSE levels in patients who failed the initial BAEP test were significantly higher than those who passed the test (25.69±4.12 μg/L vs 17.15±3.09 μg/L; P<0.01). Serum NSE levels had a positive correlation with wave V reaction threshold detected in the BAFP test (P<0.05). CONCLUSIONS: The serum level of NSE is closely correlated with BAEP, and it may be useful to the evaluation of the hearing impairment and the outcome in neonates with asphyxia.