新生儿窒息心肌酶谱的测定及临床分析

目的:探讨窒息新生儿血清心肌酶在判断缺氧程度与缺血缺氧性脑病(HIE)中的临床意义。方法:选择58例窒息新生儿,分为新生儿重度窒息(无合并症)组、窒息合并轻中度HIE组、窒息合并重度HIE组,均于生后12～24h内采动脉血,分别测定血清中谷草转氨酶(AST)、α-羟丁酸脱氢酶(HBDH)、L-乳酸脱氢酶(LDH)、乳酸脱氢酶同工酶(LDH-1)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)的活性。结果心肌酶谱活性的变化与新生儿窒息程度、HIE的发生及程度呈正相关,差异有显着性(P<0.05,P<0.01,P<0.001),即病程越重心肌酶升高越明显。结论心肌酶对判断缺氧程度、判断病情、指导治疗有重要的临床意义。     

血清肌酸激酶及同工酶在胎盘植入中的诊断价值

目的 探讨血清肌酸激酶(CK)及同工酶测定在胎盘植入中的诊断价值.方法 2004年1月至2007年1月在中山市人民医院测定33例正常产妇及85例临床疑诊胎盘植入产妇血清CK及同工酶.结果 胎盘植入产妇31例血清CK水平为(143.1±28.5)U/L,其中MBl3%,MM87%,BB未测出,胎盘粘连产妇26例血清CK水平为(76.3±25.4)U/L,其中MB4%,MM96%,BB未测出;其他产妇38例血清CK水平为(69.3±24.4)U/L,其中MB 5%,MM 95%,BB未测出.正常产妇33例血清CK水平为(68.4±24.4)U/L,其中MB 4.5%,MM 94.5%,BB未测出.胎盘植入组产妇血清CK水平明显高于胎盘粘连组、其他产妇组和正常产妇组,差异有统计学意义(P＜0.01),且其中MB型所占比例明显升高,各组BB型均未测出,以CK活性为96U/L作为诊断胎盘植入的界值,敏感性为91.3%,特异性为89.0%,阳性预测值83.8%,阴性预测测值96.9%.结论 测定血清肌酸激酶及其同工酶在胎盘植入中的产前诊断有重要的临床意义.     

新生儿窒息后Tei指数与血清心肌酶的关系

目的 探讨新生儿窒息后Tei指数与血清心肌酶的关系.方法 超声心动图测定44例轻度窒息新生儿、27例重度窒息新生儿及20例正常新生儿的二尖瓣口舒张期血流频谱E峰、A峰及E/A值、左心室射血分数、等容收缩间期、等容舒张间期及Tei指数,同时取其静脉血测定天冬氨酸氨基转移酶、肌酸激酶及其同工酶、乳酸脱氢酶、羟丁酸脱氢酶和肌钙蛋白T水平.组间差异比较采用单因素方差分析,两两比较用q检验,Tei指数与血清心肌酶间的关系采用直线相关分析.结果 (1)Tei指数、等容收缩间期及等容舒张间期在重度窒息组分别为0.62±0.13、(47±7)ms和(52±8)ms,均高于轻度窒息组[分别为0.51±0.14、(41±6)ms和(43±6)ms],轻度窒息组高于正常对照组[分别为0.39±0.12、(34±6)ms和(37±6)ms],差异均有统计学意义(P均<0.01).(2)天冬氨酸氨基转移酶、肌酸激酶及其同工酶、乳酸脱氢酶、羟丁酸脱氢酶和肌钙蛋白T在轻度窒息组高于正常对照组(P<0.01),重度窒息组高于轻度窒息组(P<0.01).(3)Tei指数、等容收缩间期及等容舒张间期均与血清心肌酶水平呈正相关(P<0.01).其中Tei指数与肌酸激酶及其同工酶和肌钙蛋白T相关性更明显(r分别为0.762、0.821、0.778,P均<0.01).结论 Tei指数可与血清心肌酶联合应用,评价新生儿窒息后心肌损害患儿的心脏功能,更可准确和动态监测与评估心功能不全的程度.     

子痫前期孕妇血清与胎盘尿紧张素Ⅱ的表达及意义

目的:检测子痫前期孕妇外周血和新生儿脐血血清中尿紧张素Ⅱ(urotensinⅡ,UⅡ)水平和UⅡmRNA在胎盘组织的表达水平,探讨其在子痫前期发生发展中的作用。方法:(1)ELISA测定30例子痫前期患者及15例正常晚期妊娠孕妇(对照组)外周血和新生儿脐血血清UⅡ水平;(2)用RT-PCR法检测各组孕妇胎盘组织中UⅡmRNA的表达水平。结果:(1)重度子痫前期组孕妇外周血血清UⅡ水平明显高于轻度子痫前期组和对照组,差异均有显著性(P<0.05)。轻度和重度子痫前期组的脐静脉血清UⅡ浓度均明显高于对照组(P<0.05,P<0.001)。(2)胎盘组织UⅡmRNA表达水平在轻度和重度子痫前期组均明显高于对照组,差异有显著性(P<0.05)。结论:UⅡ可能参与子痫前期全身小血管痉挛的机制并在胎盘组织缺血缺氧和动脉粥样硬化的发生起重要作用。     

新生儿缺氧缺血性脑病脐血白细胞介素8与肿瘤坏死因子及脂联素水平检测的意义

目的探讨脐血白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)与脂联素(ADP)水平检测对于新生儿缺氧缺血性脑病(HIE)病情和进展评估的意义。方法选择足月HIE60例和对照组30例。均抽取新生儿脐动脉血,采用ELISA法检测脐血血清IL-8,TNF-α和ADP水平。结果轻度HIE患儿脐血ADP明显低于对照组,而IL-8和TNF-α水平明显高于对照组,差异均有统计学意义(P0.05);3种因子变化在中度和重度HIE患儿脐血中表达更为明显(P0.01)。ADP与IL-8、TNF-α均呈明显负相关(P0.05)。结论脐血ADP和IL-8和TNF-α可作为缺氧缺血性脑病病情进展的判断指标。     

晚发型母乳性黄疸对患儿心肌损害的临床研究

目的 探讨晚发型母乳性黄疸对患儿心肌细胞影响及早期干预治疗的临床价值。方法 回顾复习本院儿科中心2020年4月至2022年1月收治的晚发型母乳性黄疸患儿86例病历资料,依据胆红素水平分别分为轻度组和中重度组。选取同期在本院儿童保健门诊查体足月健康新生儿60例为对照组。研究组患儿于入院当日黄疸高峰期、黄疸消退期留取静脉血2～3 mL检测血清总胆红素、心肌酶谱(CK、CK-MB)、肌钙蛋白I(cTnI);对照组常规检测上述项目,并对检测结果进行统计学分析。结果 在黄疸高峰期,中重度组心肌酶谱(CK、CK-MB)、cTnI水平较轻度组和对照组均有升高,差异均有统计学意义(P<0.05);轻度组心肌酶谱(CK、CK-MB)、cTnI水平与对照组比较差异无统计学意义(P>0.05)。在黄疸消退期,轻度组、中重度组心肌酶谱(CK、CK-MB)、cTnI水平与对照组比较差异均无统计学意义(P>0.05)。中重度组患儿黄疸高峰期,cTnI检出率为51.4%(18/35),明显高于CK、CK-MB检出率[17.1%(6/35),25.7%(9/35)],差异有统计学意义(P<0....     

血浆D-二聚体、血清CRP、血清尿酸与妊娠期高血压关系的研究

目的:探讨血浆D-二聚体、血清CRP、血清尿酸与妊娠期高血压关系。方法:随机选取妊娠期高血压孕妇150例,其中轻度子痫前期组75例,重度子痫前期组75例,选取同期同孕周正常妊娠单胎孕妇75例为对照组。对三组患者的血浆D-二聚体、血清CRP、血清尿酸水平进行比较分析,评价其在妊娠期高血压疾病评估中的价值。结果:轻,重度子痫前期组血浆D-二聚体、血清CRP、血清尿酸均明显高于正常妊娠对照组,差异有统计学意义(P<0.01);重度子痫前期组血浆D-二聚体、血清CRP、血清尿酸均明显高于轻度子痫前期组,差异有统计学意义(P<0.01)。结论:血浆D-二聚体、血清CRP、血清尿酸水平可作为监测妊娠期高血压疾病病情严重程度的指标,其检测值越高提示病情越重。     

窒息新生儿抗凝血酶Ⅲ血管性假血友病因子及D 二聚体测定及其临床意义

目的探讨窒息新生儿血浆中抗凝血酶Ⅲ(AT Ⅲ)、血管性假血友病因子(VWF)、D 二聚体(D D)的变化及其意义。 方法深圳市人民医院于2002~2004年，采用酶联荧光分析法和发色底物法分别测定39例不同程度窒息新生儿和16名正常新生儿VWF、D D的水平及AT Ⅲ的活性，同时检测血小板计数(BPC)、凝血酶原时间(PT)、纤维蛋白原(Fbg)的变化。 结果重度窒息组的AT Ⅲ明显降低；窒息新生儿血浆的VWF、D D平均值均有不同程度增高，重度窒息组升高更为显著，与正常对照组比较，其差异具有显著性意义(P<0.05，P<0.01)。窒息后并发器官功能损害新生儿较无并发症组血浆的VWF、D D均有不同程度的升高，以颅内出血患儿升高最为明显(P<0.05，P<0.01)。 结论窒息新生儿表现以高凝状态为主的早期DIC、VWF及D D的升高与窒息的程度有关，VWF及D D明显升高者常合并组织器官损害。测定窒息新生儿血浆中AT Ⅲ、VWF、D D等指标对窒息后新生儿临床选用抗凝药物治疗及疗效观察、预后判断,均有一定的指导意义。     

子痫前期患者血清及胎盘组织中人类白细胞抗原G的表达研究

目的:检测正常晚期妊娠妇女及子痫前期患者胎盘组织HLA-G的表达及血清中sHLA-G的浓度,探讨HLA-G在子痫前期发病中的临床意义。方法:用半定量逆转录-聚合酶链技术(RT-PCR)检测37例正常晚期妊娠妇女(正常妊娠组)及41例子痫前期患者(轻度20例,重度21例)胎盘组织中HLA-G mRNA的表达;并用ELISA检测血清sHLA-G浓度。结果:(1)子痫前期胎盘组织中HLA-G mRNA表达水平分别为:轻度0.402±0.104、重度0.329±0.09,明显低于正常妊娠组的0.628±0.117(P<0.01),轻、重度差异亦有统计学意义(P<0.05)。(2)子痫前期血清sHLA-G浓度:轻度45.5±11.9u/ml,重度31.2±10.3u/ml,均明显低于正常妊娠组的105.7±12.5u/ml(P<0.01),轻重度差异亦有统计学意义(P<0.01)。(3)子痫前期患者血清sHLA-G浓度与胎盘组织HLA-G mRNA表达水平呈正相关(r=0.702,P<0.01)。结论:子痫前期血清sHLA-G浓度及胎盘组织中HLA-G表达水平均明显降低,可能与子痫前期发病及病情轻重程度相关。     

胰岛素样生长因子I、生长抑素在新生儿缺氧缺血性脑病血液中水平变化的研究

目的　观察胰岛素样生长因子 I(insulin- like growth factor- I,IGF- I)、生长抑素(som atostatin,SS)在新生儿缺氧缺血性脑病 (hypoxic- ischemic encephalopathy,HIE)极期和恢复期血液中的变化 ;探讨 IGF- I、SS在 HIE发病机制中的作用。　方法　 (1)用放射免疫分析法 (RIA)测定正常对照组、HIE极期、恢复期血浆 SS的水平。(2 )用免疫放射分析 (IRMA)测定上述标本血清中 IGF- I的水平。　结果　 (1) HIE极期、恢复期与正常对照组 IGF- I、SS水平有显著差异 (F=78.7,P<0 .0 1;H=33.3,P<0 .0 1) ,HIE极期 IGF- I、SS水平下降 ,恢复期 IGF- I、SS水平升高。(2 ) HIE轻、中、重度组间 IGF- I、SS水平比较 ,均有显著差异 (F=3.38,P<0 .0 5 ;H=6 .46 ,P<0 .0 5 ) ,病情越重 ,IGF- I、SS水平越低。　结论　 (1) HIE极期 IGF- I、SS水平下降 ,恢复期 IGF- I、SS水平升高 ,提示 IGF- I、SS在 HIE的发病机制中可能具有重要作用。(2 ) HIE时 IGF- I、SS水平下降程度与疾病轻重程度有关。IGF- I、SS检测对临床疾病严重程度的判断可能具有指导意义并可作为病情恢复与否的一个监测指标。     

缺氧缺血性脑病血和脑脊液LDH、CK及同工酶分析和相关性研究

目的　探讨不同程度缺氧缺血性脑病（ＨＩＥ） 新生儿血清乳酸脱氢酶（ＬＤＨ） 、肌酸激酶（ＣＫ）和同工酶活性变化及与脑脊液酶活性的相关性。　方法　４７ 例轻、中、重度ＨＩＥ 和３９ 例正常儿均于生后４８ 小时内进行血清ＬＤＨ 及同工酶ＬＤＨ１,２,３,４,５ 、ＣＫ 及同工酶ＣＫＭＭ,ＣＫＭＢ和ＣＫＢＢ活性检测。其中２４ 例患儿同时作血清和脑脊液酶活性的相关性分析。　结果　ＨＩＥ中度和重度组血清ＬＤＨ、ＣＫ、ＬＤＨ３ ,４,５ 和ＣＫＢＢ活性明显高于正常组和轻度组（Ｐ＜ ０．０５）,以ＬＤＨ３ 升高为著（ Ｐ＜０．０１）。血清和脑脊液ＬＤＨ３ ,４,５ 、ＣＫ 和ＣＫＢＢ活性呈良好正相关（ Ｐ＜ ０．０５）,其中ＣＫＢＢ 呈高度正相关（ Ｐ＜ ０ ．０１） 。　结论　血清ＬＤＨ、ＣＫ 和同工酶,尤其ＣＫＢＢ、ＬＤＨ３ 活性测定可代替脑脊液酶活性的检查,可作为缺氧缺血性脑损伤及程度评价的参考指标。     

Creatine phosphokinase isoenzyme activity in umbilical artery,umbilical vein and capillary blood of newborn infants at term

Summary Serum levels of creatine phosphokinase isoenzyme pattern (CPK MM, MB, BB) were measured in cord blood and capillary blood samples of 20 healthy term infants. Total CPK activity was high but similar in all samples, the main source being derived from the CPK-MM fraction. The CPK-MB fraction was absent in cord blood. Moreover, CPK-BB activity was significantly higher in capillary blood than in cord blood. These results suggest specific organ involvement in the production of CPK fractions.     

谷氨酸和一氧化氮在新生儿缺氧缺血性脑病发病中的作用

目的　研究新生儿缺氧缺血性脑病 (HIE)患儿脑脊液谷氨酸和一氧化氮 (NO)水平变化 ,探讨二者在新生儿 HIE中的作用及相互关系。　方法　对 2 4例新生儿 HIE脑脊液谷氨酸和 NO水平进行检测 ,并与 8例对照组比较。　结果　重度 HIE组脑脊液谷氨酸和 NO水平明显高于对照组[(分别为 92± 42和 148.7± 5 .4,高于 45± 5和 83.3± 2 7.5 )μmol/ L ],谷氨酸和 NO水平呈显著正相关(r=0 .6 2 ,P<0 .0 1)。　结论　谷氨酸和 NO在新生儿 HIE的发生和发展过程中具有重要意义。     

Correlation of ominous fetal heart rate patterns and brain-specific creatine kinase

Creatine kinase isoenzyme analysis was performed on the cord blood of 125 infants who had undergone at least 30 minutes of intrapartum electronic fetal monitoring. The tracings were scored blindly according to severity of abnormal patterns, and the infants were grouped into ominous, intermediate, and normal scores. No differences were seen in creatine kinase MM or creatine kinase MB levels among the three groups. However, infants with ominous fetal heart rate patterns had higher creatine kinase BB levels and poorer outcome than infants with normal patterns.     

The effect of blood gas and Apgar score on cord blood cardiac troponin I.

OBJECTIVES: The aims of this study were to (a) establish a reference range for cardiac troponin I (cTnI) in the cord blood of healthy infants, and (b) investigate the effect of Apgar score, cord blood gas, gestational age, and creatine kinase (CK) and creatine kinase MB (CK-MB) fraction levels on cord blood cTnI levels. METHODS: 112 perinatal hypoxic and 84 control newborns without perinatal hypoxia were enrolled in this study. Cord blood samples were collected from the babies for arterial blood gas analysis, cTnI, CK and CK-MB measurements. Gestational age, birth weight, sex, Apgar score and history of fetal distress were recorded. Hypoxic ischemic encephalopathy (HIE) group, hypoxic but without HIE group and control groups were identified according to clinical observations during the first 72 h in the newborn unit. RESULTS: HIE and perinatal hypoxic without HIE groups had a significantly higher cord blood cTnI level according to the control group (1.8 ng/mL (0-13), 0 ng/ml (0-1.1) and 0 ng/ml (0-0.3) respectively). Cord blood cTnI level did not have a correlation with birth weight and gestational age (r = -0.02, p > 0.05 and r = 0.08, p > 0.05 respectively). Cord blood cTnI level also had a negative correlation with pH, bicarbonate, base deficit, and Apgar score (r = -0.40, p < 0.001; r = -0.39 p < 0.001; r = -0.45 p < 0.001; r = -0.41, p < 0.001) respectively). Cord blood cTnI level showed a positive correlation with CK and CK-MB levels (r = 0.45, p < 0.001 and r = 0.37, p < 0.001 respectively). Receiver operator curve analysis revealed that the most sensitive factor for prediction of perinatal hypoxia is cord cTnI value [area under curve = 0.929]. The optimal cut-off value of cord cTnI was 0.35 ng/ml for hypoxia. CONCLUSION: cTnI levels in the cord blood are not affected by gestational age and birth weight. cTnI together with CK and CK-MB has been found to be elevated in hypoxic infants compared to normal infants. Therefore cTnI may be an indicator for perinatal hypoxia in neonates.     

The dynamic changes of plasma neuropeptide y and neurotensin and their role in regulating cerebral hemodynamics in neonatal hypoxic-ischemic encephalopathy

Hypoxic-ischemic encephalopathy (HIE) is a common cause of neonatal encephalopathy and is one of the most important causes of neonatal death and disabilities, especially those infants with moderate to severe encephalopathy. However, the pathogenesis of HIE still remains unclear. The purpose of this study was to explore the dynamic changes in plasma neuropeptide Y (NPY) and neurotensin (NT) as well as their role in regulating cerebral hemodynamics in HIE patients. The plasma levels of NPY and NT in the umbilical artery and peripheral blood on the first, third, and seventh days after birth in 40 term infants with HIE and 40 healthy controls were measured using radioimmunoassay. On the first day of life, the blood samples were collected immediately when ultrasound examinations were finished. The ultrasound transducer was placed on the temporal fontanelle to detect the hemodynamic parameters of the middle cerebral artery, including peak systolic flow velocity, end-diastolic flow velocity, time-average mean velocity, pulsatility index, and resistance index (RI) in both groups were measured by pulse Doppler ultrasound in the first day after birth. The relationship between RI and NPY or NT was analyzed by linear regression analysis. NPY levels in umbilical blood ([mean +/- standard deviation] 615.5 +/- 130.7 ng/L) and first-day peripheral blood (355.9 +/- 57.4 ng/L) in neonates with HIE were significantly higher than those in normal newborns' blood (199.1 +/- 63.2 and 214.4 +/- 58.0 ng/L, respectively; P < 0.01). NPY levels in HIE neonates then declined to control levels on the third day after birth ( P > 0.05). However, the levels of plasma NT in umbilical blood and peripheral blood were much higher in the HIE group than those in normal newborns during the first week ( P < 0.01). The results of Doppler ultrasound examinations showed that cerebral blood flow velocity significantly decreased, whereas RI increased markedly in HIE patients compared with healthy controls ( P < 0.01). Linear regression analysis revealed that the RI was positively correlated with NPY levels ( R = 0.614; P < 0.01) and negatively correlated with NT levels ( R = -0.579; P < 0.01). The results of this study showed that there was a significant increase in plasma NPY and NT levels in HIE patients and this was strongly related to the severity of HIE, and the hemodynamic parameter RI was significantly correlated with NPY and NT. Therefore, we believe that the dynamic changes in plasma NPY or NT levels participate in the mechanisms of HIE by regulating cerebral hemodynamic changes after neonatal asphyxia occurs.     

Circulating Dickkopf-1 in hypoxic ischemic neonates

Objective: The current study aimed to determine the serum level of Dickkopf-1 (Dkk-1) in peripheral blood of neonates with hypoxic ischemic encephalopathy (HIE).

Methods: We measured serum levels of Dkk-1 by ELISA in neonates with HIE (n?=?20) within 24?h from symptom onset and in healthy controls (n?=?20).

Results: Dkk-1 serum levels increased significantly in HIE neonates than in healthy control. DKK-1 serum levels increased significantly in HIE neonates with convulsion, using multiple anti-convulsant drugs and those complicated with cranial ultrasound changes. Serum DKK-1 levels increased significantly in severe HIE patients.

Conclusion: Our study provides for the first time the evidence of releasing Dkk-1 into the circulation of neonates with HIE with higher level in severe degree.     

Status of vitamin D,antioxidant enzymes,and antioxidant substances in neonates with neonatal hypoxic-ischemic encephalopathy

Objective: To investigate the concentration of vitamin D (VD), glutathione peroxidase (GP), superoxide dismutase (SOD), malondialdehyde (MDA), and advanced oxidation protein products (AOPP) in neonates with hypoxic-ischemic encephalopathy (HIE).

Material and methods: This study was performed prospectively in term neonates treated for HIE. Samples were collected from the neonates in study and control groups at 6–14 h and on day 5 of their lives for 25-OH vitaminD3, antioxidant enzymes including GP and SOD and oxidants substances including MDA and AOPP.

Results: This study was performed with 31 term neonates with HIE and 30 healthy term neonates. Maternal VD level was statistically lower in the study group (9.8±6.8 ng/mL) than the control (16.4±8.7?ng/mL) (p?=?0.002). SOD and MDA levels were significantly high, and VD level was significantly low in the study group on the first day of life (p?=?0.001 and p?=?0.028, respectively). SOD and GP levels were significantly high in the study group on day 5 (p?<?0.05). VD was significantly low in the study group on day 5 and the proportion of subjects with VD below 5 ng/ml was significantly lower in the control group (p?=?<0.05).

Conclusion: VD has neuroprotective and antioxidant properties. We detected VD levels were low in infants with HIE and their mothers. This finding may be useful for decreasing of brain damage.     

计算机体层摄影术及B超检查对新生儿缺氧缺血性脑病的诊断价值

目的 探讨头颅计算机体层摄影术及Ｂ超检查对新生儿缺氧缺血性脑病的诊断价值以及临床意义。方法 随机选择９４例新生儿,分别行头颅ＣＴ及Ｂ超检查,并对照临床诊断,比较两种检查结果及其与临床诊断的符合情况。结果 头颅ＣＴ及Ｂ超检查对轻度ＨＩＥ的诊断与临床诊断符合率为３９％及８３％;