ADM血浆浓度的动态变化在HIE早期诊断中的临床研究

目的：通过对足月新生儿缺氧缺血性脑病（hypoxic ischemic encephalopathy,HIE）脐血浆中肾上腺髓质素（adrenomedullin,ADM）水平变化与血清神经元特异性烯醇化酶（Nenron specific enolase,NSE）动态变化及相关性研究,评价脐血ADM在HIE中的诊断价值。方法：使用放射免疫分析（RlA）测定30例正常新生儿和110例窒息足月儿的脐血在出生后24h、3d、7d ADM、NSE的动态变化。结果：①HIE组脐血ADM浓度为168.15pg/ml,较非HIE组的106.18pg/ml和对照组的103.65pg/ml明显增高,有显著性差异（P〈0.01）。②HIE组ADM浓度变化与HIE的轻、中、重程度呈正相关,与NSE浓度变化密切相关（r=0.786,P〈0.01）。HIE组出生后24h血浆ADM浓度明显增高,经治疗后,轻、中度组,第7d基本恢复正常对照组水平,而重度组仍维持较高浓度。③不同脐血ADM浓度为截断值绘制ROC曲线,最佳截断值为117.5pg/ml。ADM〉118.0pg/ml对HIE诊断的准确度为88.9%、特异性为83.3%、敏感度为91%。结论：脐血检测ADM浓度比NSE具有早期预测、快速方便、无创、更敏感的优点。脐血ADM测定在HIE早期诊断中有重要临床意义。

Study on the Clinical Diagnostic Value of Determination of Dynamic Changes of Plasma ADM Contents in Asphyxiated Full-Term Neonates with Hypoxic Ischemic Encephlopathy (HIE)

Objective To assess the clinical diagnostic value of determination of dynamic changes of plasma ADM contents in asphyxiated full-term neonates for the development and severity of HIE with special emphasis on the immediate post-delivery umbilical blood specimen.Methods Plasma adrenomedullin（ADM） and neuron-specific enolase（NSE） contents were determined with RIA dynamically（immediate post-delivery umbilical blood specimen,24h,3d,7d after delivery） in ① 32 asphyxiated full-term neonates without HIE ② 78 asphyxiated full-term neonates developing HIE and ③ 30 normal neonates（umbilical blood specimen only）.Results ①The plasma ADM contents in the umbilical blood specimen from the 32 neonates developing HIE were significantly higher than those in the 78 neonates asphyxiated but without HIE and normal neonates（168.15pg/ml vs 106.18pg/ml and 103.65pg/ml respectively）.②Dynamically,the plasma ADM and NSE contents reached peak around 24h and dropped to about the same levels in normal neonates around 7d after delivery in neonates with mild and moderate degree HIE but remained significantly higher in neonates with severe HIE.Plasma ADM levels were positively correlated with the severity of HIE as well as the NSE levels（r=0.786,P〈0.01）.③By analyzing the ROC curve and area under the curve at different umbilical blood plasma contents of ADM,we found the cut-off value was set most appropriately at 117.5pg/ml,the diagnostic accuracy for HIE was 88.9% with a sensitivity of 91% and specificity of 83.3%.Conclusion Determination of umbilical blood specimen plasma ADM contents（cut-off value 118pg/ml） was very helpful for early recognition of HIE in asphyxiated full-term neonates.