尿S-100B蛋白动态变化对早产儿脑损伤的诊断价值

目的探讨尿S-100B蛋白水平动态变化在早期诊断早产儿脑损伤中的价值。方法选择2012年1月至12月住院的胎龄35周的早产儿76例,分别留取生后24、72、120 h尿液,应用化学发光法检测S-100B蛋白含量。根据颅脑超声及磁共振成像(MRI)检查结果,将其分为脑室周围白质软化(PVL)组(16例)、脑室周围及脑室内出血(PVH-IVH)组(20例)及无脑损伤组(40例),比较各组间S-100B的变化。结果在生后24、72、120 h各时间点,无脑损伤组、PVL组和PVH-IVH组三组间尿S100B蛋白水平差异有统计学意义(P均0.01);在各时间点,均以无脑损伤组最低,PVL组最高,差异有统计学意义(P均0.01)。PVL组和PVH-IVH组尿S100B蛋白水平随时间点推移的差异有统计学意义(P均0.01);均在72 h达到高峰,120 h时有所下降。结论尿S100-B蛋白水平可作为早期预测脑损伤的敏感标志物,动态监测有助于判断疾病严重程度及评估患儿预后。     

早产儿脑室周围白质软化的发生与预后

早产儿脑室周围白质软化(periventricular leucumalacia，PVL)会造成小儿神经系统后遗症，特别是严重的运动发育障碍，已被围生、新生儿学领域多项研究结果所证实。近年来，我国早产儿、低体重儿、多胎儿的发生率、救治成功率明显升高，然而，远期不同程度的神经发育问题也随之增加，严重影响生活质量，故不同程度的早产儿脑白质病变问题日益受到重视。     

不同胎龄新生儿血清神经系统相关性蛋白的变化

目的 探讨不同胎龄(GA)新生儿早期血清神经系统相关性蛋白的变化,评价其在新生儿脑损伤中的临床意义.方法 120例不同GA的新生儿,其中无脑损伤者84例,脑损伤者36例.无脑损伤新生儿按GA分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组,其GA分别为～28周,～32周,～35周,37～41+6周.脑损伤者分为足月儿缺氧缺血性脑病(HIE)组,早产儿脑损伤(PBL)组.根据GA分别选取无脑损伤的足月儿28例(健康足月儿组)和早产儿20例(NPBL组)作为脑损伤患儿的对照.所有观察对象于生后2～3 d以酶联免疫吸附试验测定血清神经特异性烯醇化酶(NSE)、S100蛋白(S100)、髓鞘碱性蛋白(MBP),其中27例于出生7 d后再次测定.结果 (1)Ⅰ、Ⅱ、Ⅲ、Ⅳ组的血清NSE、MBP、S100水平差异无显著性(P＞0.05).出生3d内及7 d后血清MBP水平差异无显著性(P＞0.05),而NSE、S100不同日龄差异均有显著性(P＜0.05).MBP、NSE与GA无明显相关性,S100与GA轻度负相关(r=-0.270,P＜0.05).(2)HIE组与健康足月儿组的血清NSE水平分别为(97.16±63.00)μg/L、(35.60±25.08)μg/L,差异有非常显著性(P＜0.01),而MBP、S100两组比较,差异无显著性(P＞0.05);PBL组与NPBL组比较,血清NSE、MBP、S100差异均无显著性.结论 (1)S100血清浓度受新生儿GA的影响,而NSE、MBP与GA无关.NSE、S100血清浓度随生后日龄而变化,MBP则相对稳定.(2)NSE是早期反映HIE的指标,而MBP、S100对HIE的早期诊断价值有限.血清NSE、MBP、S100的变化对早产儿脑损伤的早期诊断价值有限.     

白细胞介素-8和细胞间黏附分子-1在早产儿脑白质损伤早期变化及其与预后的关系

目的探讨脑白质损伤(CWMD)早产儿早期血清白细胞介素-8(IL-8)和细胞间黏附分子(ICAM-1)变化及其与预后的关系。方法对2009年3月至2012年6月收治并获得随访的102例CWMD早产儿(CWMD组)和42例正常早产儿(对照组),分别在生后48~72 h采集血清并检测IL-8和ICAM-1含量,12个月时采用Bayley婴幼儿发育量表对婴儿运动发育指数(PDI)及智能发育指数(MDI)进行评估,分析IL-8和ICAM-1水平与预后的相关性。结果轻、中、重CWMD组及对照组间血清IL-8和ICAM-1水平的差异有统计学意义(P0.05),且随着CWMD程度加重,IL-8和ICAM-1水平逐渐递增,差异有统计学意义(P均0.05)。轻、中、重CWMD组的PDI、MDI的差异有统计学意义(P0.05),且随着CWMD程度加重,逐渐递减,差异也有统计学意义(P均0.05)。CWMD组的血清IL-8和ICAM-1水平与MDI之间呈显著负相关(r=-0.64、-0.66,P均0.05),与PDI之间也呈显著负相关(r=-0.70、-0.71,P均0.05)。结论 CWMD早产儿出生后血清IL-8和ICAM-1水平显著增高,并且与其12月龄时的MDI及PDI呈显著负相关。     

早产儿脑白质损伤的影像学诊断进展

早产儿脑白质损伤（white matter damage,WMD）,指24～35周出生的早产未熟儿由血管损伤和炎症反应而致的大脑白质病变,是早产儿最常见的脑损伤形式。19世纪中叶Parrot和Virchow等首先记载了本症,1962年Banker和Larroche又对本症做了详细报道,确定了PVL的概念。该病是导致早产儿伤残的重要原因。特别是脑室周围白质软化,[第一段]     

外部性脑积水血清和脑脊液髓鞘碱性蛋白的变化

目的　探讨围生期高危因素造成外部性脑积水 (EH)小儿的血清及脑脊液髓鞘碱性蛋白 (MBP)检测的临床意义。方法　采用华西医大陈俊杰报道的ELISA法对入组病例血清及脑脊液进行定量分析。结果　入组病例血清及脑脊液MBP值均高于对照组 (P <0 .0 1 ) ,并有显著差异。结论　高危因素所致EH小儿存在脱髓鞘病理改变和血脑屏障破坏 ,其脑脊液中MBP含量升高 ,小儿血脑屏障发育不完善 ,血清MBP亦升高 ,故对血清及脑脊液MBP的含量测定可做为脑损害的指标之一     

早产儿血清S100B蛋白与脑损伤的关系

目的：探讨血清S100B蛋白在早产儿脑损伤中的变化及意义。方法：47名早产儿纳入本研究,根据影像学MRI和头颅B超检查结果分为无脑损伤组（20 例）、非脑白质损伤组（14例）和脑白质损伤组（13例）。留取生后＜24 h、72 h及7 d的血清样本,采用酶联免疫吸附测定法（ELISA）双抗体夹心法测定S100B蛋白水平。结果：脑白质损伤组和非脑白质损伤组出生后24 h、72 h及7 d血清S100B蛋白水平均明显高于无脑损伤组（P＜0.05）,且脑白质损伤组血清S100B蛋白水平在各监测时间点明显高于非脑白质损伤组（P＜0.05）。结论：脑损伤早产儿生后7 d内血清S100B蛋白水平增高,提示血清S100B蛋白可以作为一种脑损伤的早期敏感标志物,对于临床早产儿脑损伤特别是脑白质损伤的诊断更有意义。     

早产儿脑室周围白质软化20例B超表现及分析

目的　分析早产儿脑室周围白质软化 (PVL)的超声表现以及预后。方法　对入住福建省妇幼保健院新生儿科所有早产儿进行常规床边头颅B超检查,对确诊为PVL的早产儿进行PVL超声图像分析并定期随访。结果　1996年底至 2004年 7月间经常规床边B超检查确诊为PVL的早产儿共 20例,其中 19例初次B超检查时间为(4 20±0 85)d,均在超声中表现为双侧脑室前角、体部或三角部外上方对称性强回声区。1例因故迟至 29日龄进行初次B超检查,显示双侧侧脑室三角部外上方已呈多发小囊腔改变。10例于 (23 6±6 1)d在原回声增强区呈现多个低回声或无回声囊腔,直径范围在 2~19 5mm,其中 2例显示囊腔分别于 41日龄和 67日龄消失。除早期死亡、自动出院及失访 12例外,余 8例患儿中,发生脑瘫 4例,疑似脑瘫 1例,其中 2例伴有智测评分低下;仅 3例 3~7个月龄随访时暂未发现异常。结论　PVL的超声表现十分典型。由于PVL患儿预后不良,对早产儿在生后早期进行常规床边头颅B超检查很有必要。     

早产儿脑损伤的相关因素分析

目的 分析早产儿脑损伤的影响因素.方法 对2006年1月至2007年10月我院收治的出生时胎龄小于36周的268例早产儿在生后7 d内行头部B超检查.并分析相关临床资料.结果 130例早产儿存在脑损伤,脑损伤的发生率为48.5%,其中脑室出血116例,发生率为43.3%,脑室周围日质软化38例,占14.2%.轻度和重度脑损伤发生率分别为23.5%、13.6%.脑损伤发生与下列因素有关:胎龄小、低出生体质量、窒息、肺透明膜病、呼吸暂停、呼吸衰竭、肺出血、低血糖、感染、低血压、凝血异常、胎膜早破以及宫内感染.结论 脑室出血以及脑室周围白质软化在早产儿中比较常见,其发生与多种因素有关.临床上应避免或治疗引起脑损伤的因素,头部B超可对早产儿脑损伤做出早期诊断.     

宫内感染与早产儿脑白质损伤相关性探讨

早产儿脑白质损伤(white matter damage,WMD)是早产儿神经系统不良预后的主要病因。脑室周围白质软化(periventricular leukomalacia,PVL)是WMD的主要表现形式。胎龄<34周的早产儿是脑白质损伤的易感者。近年来的研究认为,宫内感染是导致早产儿脑白质损伤的重要因素。绒毛膜羊     

早产儿脑室周围白质软化的影像学改变及其对预后的影响

脑室周围白质软化( periventricular leukomalacia, PVL)是早产儿具有特征性的脑损伤形式之一,易造成小儿神经系统后遗症,严重影响小儿以后的运动发育和生活质量。早产儿PVL无特异性症状,诊断依赖于影像学检查。经颅超声能对PVL做出初步诊断及预后评价。结合MRI可评价PVL患儿的损伤程度,预测可能发生的不良后果,为早期治疗提供依据。该文对早产儿PVL的影像学改变及其对预后的影响进行综述。     

我国早产儿脑室周围白质软化发生率的多中心调查报告

目的：在中华医学会儿科分会新生儿学组的发起下，国内十余家大型医院于2005年1月始进行了为期近两年的《早产儿脑损伤》多中心协作研究。该文报告我国10家三级甲等医院近两年对早产儿脑室周围白质软化（PVL）发生率的调查结果。方法：2005年1月至2006年8月期间，各参加单位对所有胎龄<37周的早产儿在生后7 d内常规进行初次床边头颅B超检查，以后每隔3～7 d复查一次，直至出院。结果：10单位共出生或收住早产儿4 933例，总PVL发生率为2.3％（112/4 933），囊性PVL发生率为0.3％（16/4 933）。分别为I级PVL 85.7％（96/112），II级PVL 12.5%（14/112），III级PVL 1.8％（2/112），无IV级PVL。4家妇婴医院的早产儿PVL总发生率非常显著低于6家综合性或儿童专科医院（1.4% vs. 2.8％）（χ2＝10.284，P<0.01）。与发生囊性PVL相关的可能高危因素为阴道分娩和机械呼吸。结论：该调查数据基本可以反映我国主要大城市早产儿PVL发生率的情况。提高对PVL尤其是非囊性脑室周围白质损伤的超声识别率，是今后临床要大力加强的重点     

Amplitude-integrated electroencephalography in preterm infants with cystic periventricular leukomalacia

Aim

This study aimed to assess amplitude-integrated electroencephalography (aEEG) findings in preterm infants with cystic periventricular leukomalacia (cPVL) in the early neonatal period.

Methods

We analyzed five infants with cPVL, whose gestational age was between 27 and 30 weeks, and 15 matched control infants. Two-channel (C3-O1 and C4-O2) aEEG was obtained by digital conversion from a conventional electroencephalogram, which was recorded at days 0-5, 6-13, and 21-34 in each infant. We evaluated the averaged two-channel values of several measurements using visual and quantitative analyses.

Results

Infants with cPVL had a significant higher maximal upper-margin amplitude value, with a median of 47.5 μV (range of 42.5-60) compared with the control infants (median, 33.8; range, 23.8-50) in the second visual-analysis record. Infants with cPVL also had a significantly higher mean upper-margin amplitude value, with a median of 18.8 μV (range, 17.7-23.2) compared with the control infants (median, 16.3; range, 10.3-19.0) in the second quantitative-analysis record.

Conclusions

We demonstrated that the upper-margin amplitude of aEEG in infants with cPVL was significantly higher than that in the control infants at 6-13 days after birth.     

Altered gene expression in umbilical cord mononuclear cells in preterm infants with periventricular leukomalacia

Aim

Periventricular leukomalacia (PVL) is one of the most important causes of adverse outcome of preterm infants. We hypothesized that inflammatory or some other specific pathways will have been activated at birth in preterm infants who later develop PVL. The aim of this study is to examine the difference in mRNA expression in umbilical cord blood according to the presence or absence of PVL.

Methods

A total of 61 umbilical cord blood samples were collected from preterm infants with gestational age less than 33 weeks together with the patients' medical information during perinatal period. RNA expression patterns in the collected cord bloods were analyzed by microarray. On the basis of cranial ultrasonography and brain MRI examination, 3 infants (4.9%) were diagnosed as cystic PVL and selected as the subjects. Five patients who showed similar perinatal factors to those of infants with PVL but did not show PVL were selected as the normal control.

Results

Five of the 15 up-regulated genes are coding ribosomal proteins, and another encodes a translation elongation factor. Three of the 7 down-regulated genes encode proteins that may be related to immune response and/or inflammation.

Conclusions

Up-regulation of the ribosomal proteins may indicate an activation of lymphocytes during the fetal period.     

Respiratory disease and early serum S100A12 changes in very premature infants

Aim: The role of granulocyte‐specific S100A12, a marker for inflammatory disorders, in newborn lung disease is unknown. We compared postnatal blood S100A12 concentrations against respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). Methods: Blood samples from 92 newborns were collected on admission, 12 h, day 1, day 3–4 and day 7, and analysed for S100A12. IL‐8 and IL‐6 were assayed in 52 infants. Results: Infants with RDS were significantly more premature (median 27 vs. 34 weeks), more likely to receive antenatal corticosteroids (84% vs. 26%) and have lower neutrophil counts (median 2.4 vs. 3.8 × 10⁹/L) at admission. S100A12 levels peaked during the first day and were significantly lower in preterm infants with RDS compared to those without (median 250 vs. 616 ng/mL at 12 h, 281 vs. 828 ng/mL day 1, respectively). S100A12 levels were low among the 35 very preterm infants (24–29 week gestation) regardless of the presence of BPD (285 vs. 288 ng/mL on day 1). In comparison, IL‐8 and IL‐6 levels were not different between groups. Conclusion: Plasma S100A12 is low in infants with RDS, possibly because of gestationally related differences in neutrophil response or to the effects of antenatal corticosteroids. It is therefore not a useful marker of BPD development.     

Trends in severe brain injury and neurodevelopmental outcome in premature newborn infants: the role of cystic periventricular leukomalacia

OBJECTIVES: To determine if the incidence of sonographically detected cystic periventricular leukomalacia (PVL) and periventricular hemorrhagic infarction (PVHI) have changed over the past decade and to determine if a decline in cystic PVL was associated with a change in neurodevelopmental outcome. STUDY DESIGN: Premature newborn infants admitted to our intensive care nursery from 1992 to 2002 were identified in a comprehensive nursery database. Premature newborn infants had routine neurosonography by means of a standardized protocol. Infants weighing < or =1500 g at birth surviving to nursery discharge were enrolled in a nursery follow-up clinic. RESULTS: Adjusting for gestational age, there was a significant decrease in cystic PVL from 1992 to 2002 (P=.003) without a concurrent decrease in PVHI (P=0.5). Cystic PVL and PVHI accounted for only 9 of the 28 cases of cerebral palsy and 12 of 90 cases of abnormal Developmental Scores in infants weighing <1500 g at birth. The decline in cystic PVL was not associated with improved developmental outcome from 1992 to 2002. CONCLUSIONS: The incidence of cystic PVL declined significantly from 1992 to 2002 at our center. Cystic PVL was detected by ultrasound in a minority of infants with abnormal neurodevelopmental outcome, indicating that other forms of cerebral injury account for the majority of abnormal neurodevelopmental outcomes in premature newborn infants.     

组织学绒毛膜羊膜炎与小于34周早产儿脑室周围白质软化的相关性分析

目的探讨组织学绒毛膜羊膜炎(histologic chorioamnionitis,HCA)与<34周早产儿脑室周围白质软化(periventricular leukomalacia,PVL)的相关性。方法选取2018年1月至12月于青岛市妇女儿童医院产科出生、孕母行胎盘病理检查并转入NICU接受治疗、胎龄<34周的早产儿作为研究对象,共计287例。根据孕母胎盘病理检查结果分为HCA阳性组(167例)和HCA阴性组(120例),比较2组患儿的PVL发生率。将研究对象中已诊断为PVL的41例早产儿,根据孕母胎盘病理检查结果及HCA分期标准,分为非HCA组、HCA早期组、HCA中晚期组3组,比较各组PVL严重程度、患儿临床资料、并发症及校正胎龄至6月龄时的随访情况。结果HCA阳性组PVL占19.16%(32/167),HCA阴性组PVL占7.50%(9/120),2组PVL发生率比较差异有统计学意义(P<0.05)。已诊断为PVL的<34周早产儿中,非HCA组21.95%(9/41),HCA早期组31.71%(13/41),HCA中晚期组46.34%(19/41),3组间PVL严重程度、1 min Apgar评分、生后24 h白细胞计数、支气管肺发育不良发生率、住院天数、抗生素应用天数、校正胎龄至6月龄时的智力发育指数(mental development index,MDI)和精神运动发育指数(psychomotor development index,PDI)比较差异均有统计学意义(P均<0.05),且HCA炎症程度与PVL严重程度呈正相关(rs=0.374,P=0.016)。结论HCA与<34周早产儿PVL的发生有相关性,随着HCA炎症程度增加,PVL的发生率、严重程度增加。母亲存在HCA的<34周早产儿随炎症严重程度进展,其生后24 h白细胞计数升高,支气管肺发育不良发生率、抗生素使用率增加,住院时间延长,校正胎龄至6月龄时MDI、PDI分数降低。     

中国人群早产儿脑室周围白质软化危险因素的meta分析

目的探讨中国人群早产儿发生脑室周围白质软化的主要危险因素,为今后防治工作提供依据。方法利用meta分析方法分析国内14篇关于早产儿脑室周围白质软化危险因素的研究文献。累计病例748例,对照3 366例。根据齐性检验结果选择计算各危险因素合并比值比(OR)及其95%可信区间(95%CI)模型。结果脑室周围白质软化发生的OR值(95%CI)分别为:产前使用激素0.46(0.34～0.61),胎膜早破3.60(1.40～9.24),胎龄5.05(2.66～9.58),低出生体质量2.78(2.30～3.35),重度窒息5.35(2.09～13.68),感染4.46(3.08～6.44),机械通气3.67(1.74～7.72),低碳酸血症4.49(2.03～9.94),脑室内出血2.00(1.15～3.45),酸中毒1.58(1.19～2.08)。结论胎膜早破、胎龄、低出生体质量、重度窒息、感染、机械通气、低碳酸血症、脑室内出血和酸中毒是中国人群早产儿脑室周围白质软化发病的主要危险因素,产前使用激素可能为脑室周围白质软化的保护因素。