血清高迁移率族蛋白B1及胶质纤维酸性蛋白水平预测新生儿缺氧缺血性脑病预后的价值

目的探讨血清高迁移率族蛋白B1(HMGB1)及胶质纤维酸性蛋白(GFAP)水平对预测新生儿缺氧缺血性脑病(HIE)预后的价值。方法选取儋州市人民医院收治的HIE患儿115例,根据其预后情况分成存活组(87例)和死亡组(28例)。采用神经症状临床分度分为轻-中度组80例和重度组35例,比较各组第1天、第3天、第5天血清HMGB1及GFAP水平变化。应用受试者工作特征(ROC)曲线分析血清HMGB1及GFAP水平对预测HIE患儿死亡的价值。结果死亡组在第1天、第3天、第5天血清HMGB1水平[(9. 35±3. 24)μg/L,(13. 60±4. 18)μg/L,(18. 64±6. 95)μg/L]及GFAP水平[(152. 80±44. 72) ng/L,(186. 24±53. 40) ng/L,(227. 50±64. 38) ng/L]均明显高于存活组相应时间点的HMGB1水平[(5. 80±2. 16)μg/L,(6. 12±2. 28)μg/L,(4. 70±1. 82)μg/L]及GFAP水平[(103. 60±31. 52) ng/L,(120. 38±34. 75) ng/L,(115. 60±32. 42) ng/L],差异有统计学意义(P 0. 05);且死亡组血清HMGB1及GFAP水平随时间推移呈升高趋势(P 0. 05)。重度组在第1天、第3天、第5天血清HMGB1水平[(9. 14±3. 15)μg/L,(12. 75±3. 84)μg/L,(16. 90±6. 42)μg/L]及GFAP水平[(145. 20±40. 83) ng/L,(172. 80±48. 63)ng/L,(213. 80±62. 42) ng/L]均明显高于轻-中度组相应时间点的HMGB1水平[(6. 38±2. 37)μg/L,(6. 63±2. 40)μg/L,(5. 82±2. 14)μg/L]及GFAP水平[(112. 73±33. 60) ng/L,(131. 46±36. 72) ng/L,(124. 73±34. 58)ng/L),差异有统计学意义(P 0. 05);且重度组血清HMGB1及GFAP水平随时间推移呈升高趋势(P 0. 05)。ROC曲线显示,第3天血清HMGB1水平联合GFAP水平预测HIE患儿死亡的曲线下面积最大(0. 926,95%CI:0. 862～0. 974),其敏感度和特异度为93. 0%和87. 3%。相关分析显示,死亡组血清HMGB1水平与GFAP水平呈正相关(r=0. 806,P 0. 01)。结论血清HMGB1及GFAP水平升高与HIE患儿的病情严重程度相关,第3天两项联合检测预测HIE患儿预后的价值较高。

Value of the serum levels of high-mobility group box B1 and glial fibrillary acidic protein in predicting the prognosis of neonatal hypoxic-ischemic encephalopathy

Objective Toinvestigate the value of the serum levels of high-mobility group box B1 (HMGB1) and glial fibrillary acidic protein (GFAP) in predicting the prognosis of neonatal hypoxic-ischemic encephalopathy (HIE).Methods A total of 115 children with HIE who were admitted to Danzhou People's Hospital were enrolled, and according to their prognosis, they were divided into survival group with 87 children and death group with 28 children. According to the clinical classification of neurological symptoms, they were divided into mild-moderate group with 80 children and severe group with 35 children. Serum levels of HMGB1 and GFAP on days 1, 3, and 5 were compared between groups. The receiver operating characteristic (ROC) curve was used to analyze the value of serum HMGB1 and GFAP levels in predicting death in children with HIE.Results Compared with the survival group on days 1, 3, and 5, the death group had significantly higher serum levels of HMGB1 (9.35±3.24/13.60±4.18/18.64±6.95 μg/L vs 5.80±2.16/6.12±2.28/4.70±1.82 μg/L, P<0.05) and GFAP (152.80±44.72/186.24±53.40/227.50±64.38 ng/L vs 103.60±31.52/120.38±34.75/115.60±32.42 ng/L, P<0.05), and the serum levels of HMGB1 and GFAP tended to increase over time in the death group (P<0.05). Compared with the mild-moderate group on days 1, 3, and 5, the severe group had significantly higher serum levels of HMGB1 (9.14±3.15/12.75±3.84/16.90±6.42 μg/L vs 6.38±2.37/6.63±2.40/5.82±2.14 μg/L, P<0.05) and GFAP (145.20±40.83/172.80±48.63/213.80±62.42 ng/L vs 112.73±33.60/131.46±36.72/24.73±34.58 ng/L, P<0.05), and the serum levels of HMGB1 and GFAP tended to increase over time in the severe group (P<0.05). The ROC curve analysis showed that the serum levels of HMGB1 and GFAP on day 3 had the largest area under the ROC curve of 0.926 (95% confidence interval[CI]:0.862-0.974), with a sensitivity of 93.0% and a specificity of 87.3%. The correlation analysis showed that serum HMGB1 level was positively correlated with serum GFAP level in the death group (r=0.806, P<0.01).Conclusions Increases in the serum levels of HMGB1 and GFAP are associated with disease severity in children with HIE, and the serum levels of HMGB1 and GFAP on day 3 have a high value in predicting the prognosis of children with HIE.