监测窒息新生儿血清BDNF、S100B及aEEG动态变化及对脑损伤预测价值

目的探讨监测窒息新生儿血清脑源性神经营养因子（BDNF）、S100B蛋白及振幅整合脑电图（aEEG）动态变化，分析其对脑损伤的预测价值。 方法选择2019年6月至2021年3月上海交通大学附属苏州九龙医院收治的103例窒息新生儿（窒息组）和39例健康足月新生儿（对照组），其中窒息组新生儿又被分为轻度窒息组（1/5 min Apgar评分＜7分，脐动脉血气分析pH＜7.2，65例）和重度窒息组（1/5 min Apgar评分＜5分，脐动脉血气分析pH＜7.0，38例）。于受试儿出生后6 h、24 h、3 d检测血清BDNF、S100B水平，行aEEG检查分析脑电波背景活动，窒息新生儿出生后第7天行颅脑MRI检查。二元Logistic回归分析BDNF、S100B、脑电波背景活动与窒息新生儿脑损伤的关系。受试者工作特征曲线（ROC）分析BDNF、S100B、脑电波背景活动鉴别窒息新生儿脑损伤的价值。 结果轻度窒息组和重度窒息组患儿出生后6 h、24 h、3 d血清BDNF、S100B水平呈先增高后下降的趋势（P＜0.05），重度窒息组出生后6 h、24 h、3 d血清BDNF、S100B水平高于轻度窒息组和对照组（P＜0.05）。出生后6 h、24 h、3 d脑电波背景活动与窒息程度呈正相关（r_s=0.776、0.895、0.735，P均＜0.05）。本组103例窒息新生儿发生脑损伤41例，出生后24 h的高BDNF、高S100B、脑电波背景活动重度异常与窒息新生儿脑损伤的发生有关（P＜0.05）。联合出生后24 h的BDNF、S100B、脑电波背景活动诊断窒息新生儿脑损伤的曲线下面积为0.911，高于单独诊断的0.696、0.697、0.707（P＜0.05）。 结论出生后24 h血清BDNF、S100B水平升高，aEEG脑电波背景活动严重异常与窒息新生儿脑损伤的发生有关，监测血清BDNF、S100B及aEEG有助于评估窒息新生儿脑损伤风险。

Dynamic changes of serum BDNF,S100B,and aEEG in asphyxia neonates and their predictive value for brain injury

ObjectiveTo investigate the dynamic changes of serum brain-derived neurotrophic factor (BDNF), S100B protein, and amplitude integrated electroencephalogram (aEEG) in neonates with asphyxia, and to analyze their predictive value for brain injury. MethodsA total of 103 neonates with asphyxia (asphyxia group) and 39 healthy full-term neonates (control group) treated at Suzhou Kowloon Hospital, Shanghai Jiao Tong University from June 2019 to March 2021 were selected. The children with asphyxia were further divided into a mild asphyxia subgroup (1/5 min Apgar score <7 points, umbilical artery blood gas analysis pH <7.2; 65 cases) and a severe asphyxia subgroup (1/5 min Apgar score <5 points, umbilical artery blood gas analysis pH <7.0; 38 cases). Serum BDNF and S100B levels were detected at 6 h, 24 h, and 3 d after birth, EEG examination was performed to analyze the EEG background activity, and craniocerebral MRI examination was performed at 7 d after birth for asphyxia neonates. The relationship between BDNF, S100B, and brainwave background activity and brain injury in asphyxia neonates was analyzed by binary Logistic regression. Receiver operating characteristic curve (ROC) analysis was performed to assess the value of BDNF, S100B, and brainwave background activity in differentiating brain injury in asphyxia neonates. ResultsSerum BDNF and S100B levels of children in the mild asphyxia subgroup and severe asphyxia subgroup were first increased at 6 h after birth and then decreased at 24 h and 3 d after birth (P＜0.05). Serum BDNF and S100B levels in the severe asphyxia subgroup were higher than those in the mild asphyxia subgroup and control group at 6 h, 24 h, and 3 d after birth (P＜0.05). EEG background activity was positively correlated with asphyxia degree at 6 h, 24 h, and 3 d after birth (r_s=0.776, 0.895, and 0.735, respectively, P＜0.05). There were 41 cases of brain injury in 103 neonates with asphyxia. High BDNF, high S100B, and severe abnormal EEG background activity at 24 h after birth were related to the occurrence of brain injury in neonates with asphyxia (P＜0.05). The area under the curve of combined BDNF, S100B, and EEG background activity at 24 h after birth in the diagnosis of brain injury in asphyxia neonates was 0.911, which was higher than those of them alone (0.696, 0.697, and 0.707, respectively, P＜0.05). ConclusionIncreased serum BDNF, S100B, and aEEG levels and severe abnormal EEG background activity 24 h after birth are associated with the occurrence of brain injury in neonates with asphyxia. Monitoring serum BDNF, S100B, and aEEG is helpful to assess the risk of brain injury in neonates with asphyxia.