高胆红素血症新生儿血清脑型同工酶、神经元特异性烯醇化酶的变化及其意义

目的探讨高胆红素血症新生儿血清脑型同工酶（CK—BB）、神经元特异性烯醇化酶（NSE）的变化及其对脑损伤的诊断意义。方法选择2010年1月～2012年12月河北省唐山市丰润区第二人民医院收治的高胆红素血症新生儿80例为研究组，患儿根据胆红素水平分为轻度胆红素血症组及重度胆红素血症组．选择同期健康足月新生儿80例为对照组，测定各组患儿血清NSE、CK—BB及总胆红素（TSB）水平，并采用神经行为测定（NBNA）方法评价患儿神经功能．比较两组NSE、CK—BB、TSB、NBNA水平，并分析NSE、CK—BB与患儿NBNA评分的关系。结果研究组NSE、CK—BB、TSB水平明显高于对照组，NBNA评分明显低于对照组，两组比较差异有统计学意义（t=6．745、7．932、16．918、4．803，P〈0．05或P〈0．01）。研究组患儿中，重度组NSE、CK—BB、TSB水平明显高于轻度组，NBNA评分明显低于轻度组，两组差异有统计学意义（t=7．029、3．954、11．237、4．034，P〈0．05或P〈0．01）。相关性分析结果显示，高胆红素血症新生儿NSE、CK—BB水平与NBNA评分均呈负相关（r=-0579、-0．437，P〈0．05），NSE、CK—BB水平与TSB水平呈正相关（r=0．412、0．596，P〈0．05）。结论高胆红素血症新生儿NSE、CK—BB水平显著升高，且两者与TSB呈正相关，与NBNA评分呈负相关，提示随着胆红素水平的升高，患儿脑损伤加重，临床可以将NSE、CK—BB作为脑损伤的敏感指标。

Changes and diagnostic significance of NSE,CK-BB in neonatal bilirubin encephalopathy

Objective To investigate the changes and diagnostic significance of NSE, CK-BB in neonatal bilirubin encephalopathy. Methods 80 cases of neonatal hyper.bilirubinemia admitted to the Second People＇s Hospital of Fengrun District in Tangshan City of Hebei Province from January 2010 to December 2012 were selected as study group, and they were divided into mild hyperbilirubinemia group and severe hyperbilirubinemia group, 80 cases of healthy term newborns over the same period were selected as the control group. The serum NSE, CK-BB and total bilirnbin （TSB） levels of each group were detected, and neurobehavioral determination （NBNA） was used to evaluate neurological function of all patients, NSE, CK-BB, TSB, NBNA level of each group were compared, and the relationship between NSE, CK-BB and NBNA score was analyzed. Results The NSE, CK-BB, TSB level of study group were significantly higher than control group, NBNA score was significantly lower than the control group, the differences were statistically significant （t = 6.745, 7.932, 16.918, 4.803, P 〈 0.05 or P 〈 0.01）. In study group,the NSE, CK-BB, TSB level of severe group were significantly higher than the mild group, NBNA score was significantly lower than the mild group, the differences were statistically significant （t = 7.029, 3.954, 11.237, 4.034, P 〈 0.05 or P 〈 0.01）. Correlation analysis showed that the NSE, CK-BB level was negatively correlated with NBNA score （r = -0.579, -0.437, P 〈 0.05）, NSE, CK-BB level were positive correlated with NBNA score （r = 0.412, 0.596, P 〈 0.05）. Conclusion NSE, CK-BB level of neonate with hyperbilirubinemia has significantly increased, and both are positively correlated with TSB, negatively correlated with NBNA score, it suggests that along with bilirubin level increasing, brain injury of neonate is worsened, so NSE, CK-BB can be used as sensitive indicators of brain damage.