新生儿缺氧缺血性脑病血清NSE的变化及其与脑CT值的临床研究

目的探讨窒息后新生儿缺氧缺血性脑病(HIE)早期血清神经元特异性稀醇化酶(NSE)的变化及其与脑CT值的相关性,为临床早期诊断HIE脑损伤提供参考指标,协助判断脑损伤程度,为指导临床对治疗效果的判定和预后提供依据。方法随机选取59例符合新生儿缺氧缺血性脑病诊断标准的足月新生儿作为窒息后缺氧缺血性脑病组。窒息后HIE组根据临床表现分为轻度、中度及重度。随机选择20例生后无窒息,其母无任何疾病的健康足月新生儿作为对照组。HIE组及对照组分别测定生后24h内、第7天血清NSE的含量。颅脑CT值在生后第3～5天测定。所有计量资料均采用均数±标准差表示,组间比较采用q检验(Newman-Keuls法),对有相关趋势的变量进行相关分析,以P0.05为有统计学意义。结果 24h内,对照组NSE浓度(35.15±12.10)μg/L,轻度HIE组(56.71±21.77)μg/L,中度HIE组(109.13±60.70μ)g/L,重度HIE组(141.17±26.83)μg/L,HIE组与对照组比较差异有显著性(P0.01),并且HIE各组之间差异有显著性(P0.01)。生后第7天NSE浓度下降,轻度HIE组恢复至正常,但中度、重度HIE组仍高于对照组,与轻度HIE组及对照组相比以及中度、重度之间,差异有显著性(P0.01)。对照组3-5天脑CT检查其结果值大于20Hu。轻度HIE组脑CT值小于18Hu,中度组小于15Hu,重度组小于12Hu。HIE组与对照组比较,差异有显著性(P0.01)。通过对HIE组生后24h血清NSE水平与3-5天的脑CT值进行相关性分析,发现两因素呈显著负相关(r=-0.752,P0.001)。结论 HIE患儿血清NSE在24h内即升高,HIE组与对照组之间,HIE各组之间,差异有显著性。血清NSE在生后24h可作为窒息后脑损伤的早期指标。HIE患儿24h内血清NSE浓度水平与3-5天时脑CT值呈显著负相关,提示脑损伤程度越重,血清NSE水平越高,脑CT值越低。

Correlation between serum NSE and cerebral CT value in asphyxiated term infant with hypoxic-ischemic encephalopathy.

Objective： To investigate the activities of serum neuron-specific enolase（NSE） and the correlation between NSE and cerebral computerized tomography（CT） value in asphyxiated term newborn infant with early hypoxic-ischemic encephalopathy（HIE）.And provide the norm for Diagnoses the HIE in early time,assists to judge the xtent of brain damage,and provide instruction for treatment responds and prognosis.Methods： 59 full-term newborn infants with HIE after birth asphyxia were investigated in comparesion with 20 age-sex-matched health full-term newborn infants.HIE group fulfilled the dianosis criteria of HIE,and was subdivided to three gyoups according norm criteria.Twenty full-term newborn infant who fulfilled the following criteria were included in the control group with no maternal illness.Blood sample of two groups were collected from vein within 24h and 7d after birth.The value of NSE in serum were estimated by electrochemiluminescence.The CT scans were done at 3-5d after birth.scan the pathological part,scope and the CT value at the same time.All values were presented as Mean±s.Mean differents between the groups were calculated with the q-test.The correlation was analysed.For statistical analyses,probability values 0.05 were considered to be significant.Results： Within 24h,the level of NSE in control group was（35.15±12.10）μg/L,mild group was（56.71±21.77）μg/L,moderate group was（109.13±60.70）μg/L,and the severe group was（141.17±26.83）μg/L.There were significant differences（P0.01） among the control group,mild,moderate and severe HIE groups in 24h after birth.The values of serum NSE rose within 24h after birth and then declined at 7d,the mild group declined to nomal level,while the moderate and the severe groups still higher than control group.The differences were significant（P0.01） among the mild,moderate and severe groups.This result indicate that the higher NSE level,the more serious brain injured and the more seriously clinic symptom.There was a significant negative correlation between the level of serum NSE within 24h and the CT value of HIE group on 3rd-5th day（r=-0.752,P0.001）.The damage of brain more seriously,the level of serum NSE will be higher,while the CT value will be lower.Conclusions： The levels of NSE rose within 24h in newborn with HIE.There were significant differences between HIE groups and control group,and the same to the HIE groups.The differences were significant.The higher the NSE was in serum,the more seriously the brain damaged.The NSE level within 24h can be considered as an early indicator of HIE.There was a significant negative correlation between the level of serum NSE within 24h and the CT value of HIE group from 3rd to 5th day.The brain damage was more serious,the level of serum NSE would be higher,while the CT value would be lower.