缺氧缺血性脑病新生儿血清神经元特异性烯醇化酶、髓鞘碱性蛋白与游离钙浓度的关系

目的:探讨血清神经元特异性烯醇化酶(neuron specific enolasc,NSE)、髓鞘碱蛋白(myelin base protein,MBP)与血清游离钙(Ca2+)的水平变化在新生儿缺氧缺血性脑病(HIE)中的意义。方法:选择足月HIE患儿82例为实验组,分别在1天、3天(急性期),7天(恢复期)采血,用放免法测定NSE,用ELISA法测定MBP,日本产AFT-500型血液电解质分析仪测定血清Ca2+,30例健康新生儿作为正常对照组。结果:①HIE各组1天,3天血清NSE水平均高于对照组(P<0.05),且HIE程度越重,NSE水平越高。NSE水平以生后1天最高,3天后开始下降,轻度H1E患儿7天后基本恢复正常,而中、重度HIE患儿仍保持较高水平。②重度组HIE患儿3天MBP水平升高最明显,7天其水平下降,但仍高于对照组,生后7天轻、中度HIE组与对照组相比无明显差异。③1天、3天轻、中、重度HIE组血清Ca2+浓度较对照组有显著差异(P<0.05),病情越重,下降越明显,生后7天轻度H1E组血清Ca2+浓度恢复正常,而中、重度HIE组仍低于对照组。结论NSE是一个较为敏感的反映神经元损伤的指标,联合检测MBP、Ca2+能更好地判断病情轻重,评估预后。

The relationship of serum neuron specific enolase, myelin base protein and serum free calcium levels in neonates with hypoxic ischemic encephalopathy

Objective:To investigate the changes of serum neuron specific enolase(NSE) and myelin base protein(MBP) and serum free calcium(Ca2 ) levels in neonates with hypoxic ischemic encephalopathy(HIE).Methods:82 newborns with HIE and 30 newborns were selected as cases and controls,respectively.Radio-immunity analysis was used to determine NSE concentration.Serum levels of MBP assayed by ELISA method.The serum free calcium measured by AFT-500 prompt electrolyte analyzer.Results:(1) A significant difference was shown in serum NSE levels between HIE groups and control group on dayl and day3(P<0.05),the more severe of HIE was the higher of NSE level.On day7 NSE levels in moderate and severe HIE group staying was higher than that in mild HIE group and control group,and the differences turn to be statistically significant.(2) The MBP levels of the sever group were much higher on day3 than those of other groups(P< 0.05).On day7 a significant difference was shown in serum MBP levels between severe group and other groups.(3) On dayl,day3 serum free calcium concentration declined than control group,the more severe of HIE was the lower of Ca2 level.Conclusion:the concenUation of serum NSE had the higher sensitivity.The combination of serum NSE,MBP and Ca2 call appraise the severity and gradation of HIE.