血清中NSE及S100B蛋白检测对预测高胆红素血症早产儿胆红素脑损伤的临床意义

目的探索高胆红素血症早产儿血清中神经元特异性烯醇化酶（NSE）及星形胶质源蛋白（S100B）的测定对预测早产儿发生胆红素脑损伤的临床意义。方法选择日龄2~7 d内患高胆红素血症的早产儿112例作为观察组,另选择36例无胆红素血症的早产儿作为对照组,重氮法检测血清总胆红素（TBiL）,酶联免疫吸附法检测NSE及S100B蛋白。对部分患儿进行脑干听觉诱发电位（BAEP）检测,受试者工作曲线（ROC）分析患儿NSE、S100B蛋白、TBiL等检测方法与BAEP检测的相关性。结果观察组NSE、S100B蛋白及TBiL分别为（109.35±33.63）、（3.350±1.677）μg/L及（163.20±77.17）μmol/L,与对照组的（66.28±21.50）、（1.876±0.744）μg/L及（75.84±36.36）μmol/L比较,差异有统计学意义（P〈0.01）,且观察组NSE、S100B蛋白与TBiL之间呈正相关性。BAEP异常组与BAEP正常组TBiL分别为（299.90±88.30）μmol/L与（303.20±61.20）μmol/L,差异无统计学意义（P〉0.05）;BAEP异常组NSE、S100B蛋白分别为（144.33±33.06）、（4.259±1.195）μg/L,与BAEP正常组的（86.86±25.02）、（3.097±1.557）μg/L比较,差异有统计学意义（P〈0.01）。对患有高胆红素血症的早产儿根据TBiL水平判断BEAP的异常差异无统计学意义（P=0.727）;利用NSE、S100B蛋白预测患胆红素血症早产儿听力损害的临界点分别为110.56、3.606μg/L,NSE、S100B蛋白、TBiL预测高胆红素血症早产儿听力损害的灵敏度分别为91.00%、88.67%、53.47%,特异度分别为78.46%、70.13%、42.88%,NSE检测的灵敏度和特异度略优于S100B蛋白,两者的灵敏度与特异度均显著高于TBiL（P=0.003）。结论对患高胆红素血症的早产儿测定血清中NSE及S100B蛋白的含量对诊断早产儿胆红素脑损伤有重要价值,可作为临床上判断胆红素脑损伤的敏感指标。

The clinical significance of NSE and S100B in predicting bilirubin brain injury in preterm children with hyperbilirubinemia

Objective To explore the clinical significance of neuron-specific enolase（NSE） and serum astrocyte proteins（S100B） in predicting bilirubin brain injury in preterm children with hyperbilirubinemia.Methods 112 cases of premature children with hyperbilirubinemia in age 2-7 days were selected as observation group,and 36 cases of premature children without hyperbilirubinemia were selected as control group.The serum total bilirubin（TBiL） was detected by diazo method,NSE and S100B was tested by enzyme-linked immunosorbent assay.Brainstem auditory evoked potential（BAEP） was measured in part of children.The correlation among the NSE,S100B,TBiL and BAEP was analyzed by receiver operating curve（ROC）.Results The NSE,S100B and TBiL of observation group was（109.35±33.63） μg/L,（3.350± 1.677） μg/L and（163.20±77.17） μmol/L,compared with（66.28±21.50） μg/L,（1.876±0.744） μg/L,and（75.84±36.36） μmol/L of the control group,the difference was significant（P0.01）;The NSE,S100B in observation group had positive correlation with TBiL.The TBiL in BAEP abnormal group and BAEP normal group was（299.90±88.30） μmol/L and（303.20± 61.20） μmol/L respectively,there was no significant difference（P0.05）;The NSE,S100B in BAEP abnormal group was（144.33±33.06） μg/L,（4.259±1.195） μg/L,in BAEP normal group was（86.86±25.02） μg/L,（3.097±1.557） μg/L reapctively,there was significant difference（P0.01）.In premature children with hyperbilirubinemia,the judgment of BEAP based on the TBiL had no significant difference（P=0.727）;The critical point of hearing loss in premature child with hyperbilirubinemia predicted by NSE,S100B was 110.56 μg/Land 3.606 μg/L respectively,the s ensitivity of hearing loss in premature child with hyperbilirubinemia predicted by NSE,S100B,TBiL was 91.00%,88.67% and 53.47%,specificity was 78.46%,70.13% and 42.88% respectively,the sensitivity and specificity of NSE was better than that of S100B,the sensitivity and specificity of both NSE and S100B was significantly higher than that of TBiL（P=0.003）.Conclusion The detection of serum NSE and S100B level in premature children with hyperbilirubinemia has significant value for the diagnosis of brain injury,can be as sensitive indicator predicting bilirubin brain injury in clinic.