血清神经元特异性烯醇化酶水平与足月儿缺氧缺血性脑病颅内结构改变相关性研究

目的探讨足月儿缺氧缺血性脑病（HIE）急性期血清神经元特异性烯醇化酶（NSE）水平与颅内结构改变的相关性。方法以2006年6月至2009年6月广州市妇女儿童医疗中心收治的足月儿HIE为HIE组，分为轻度、中度和重度HIE亚组，以同期住院的非HIE新生儿为对照组。两组均于生后第1～7天检测血清NSE水平，采集急性期和急性期后至36月龄的头颅CT检查信息，探讨NSE对颅内结构改变的预测价值。结果HIE组107例（轻度HIE亚组34例，中度HIE亚组41例，重度HIE亚组32例）和对照组30例进入分析。@HIE组和对照组血清NSE水平均呈单峰分泌趋势，以生后第2天最高，之后呈下降趋势。各时点血清NSE水平中度和重度HIE亚组均高于轻度HIE亚组和对照组（P均〈0．05）。②急性期头颅CT轻度异常21例、中度异常20例、重度异常29例。以生后第2天血清NSE水平49．8ng·mL-1预测HIE组急性期头颅CT严重异常的敏感度为62．5％，特异度为86．0％。③HIE组存活99例，89例具有头颅cT随访资料，cT异常40例（40．9％），生后第2天NSE水平45．7ng·mL。预测急性期后36月龄内头颅CT异常的敏感度为71．4％，特异度为89．3％。结论中重度足月儿HIE生后2—5d血清NSE水平与急性期和急性期后头颅CT的异常改变相关。

Study on the correlation between serum neuron-specific enolase levels and the changes of intracranial structure in neonatal hypoxic-ischemic encephalopathy

Objective To study the correlation between serum neuron-specific enolase （NSE） dynamic concentration and neonatal hypoxic-ischemic encephalopathy （HIE） in its acute phase and its imaging of intracranial structure changes. Methods 107 cases of HIE were hospitalized to neonatal ward in Guangzhou Women and Children＇s Medical Center. Patient~ imaging data were statistically analyzed. According to ＂Neonatal Hypoxic-ischemic Encephalopathy Diagnostic Criteria＂ developed by the Branch of Pediatric of the Chinese Medical Association of Neonatology Group in 2005, 107 cases of the HIE were classified into mild, moderate and severe groups, respectively, serum NSE levels were determined daily from day 1 to 7. To evaluate the correlation between serum NSE levels and brain structure changes, brain CT image data were reviewed during accute phase to 36 month old. Results 34 cases of the HIE mild subgroup, 41 cases of moderate subgroup, 32 cases of severe subgroup and 30 cases of control group were analyzed. ①The NSE levels reached peak at the 2nd days after birth in both HIE group and control group, and decreased with the age. The concentrations of serum NSE in the patients with moderate and severe abnormal imaging of head CT were significantly higher than the control group and the mild group（P 〈 0.05） ; ②The mild, moderate and severe CT changes were 21, 20 and 29 patients with HIE. To predict severe CT changes with the NSE level 49.8 ng~ mL-~at the 2nd days after birth in acute phase, the sensitivity and specifity were 62.5% and 86.0%, respectively.③In survival children with HIE, the CT of 89 patients were followed up for 3 - 36 months after birth, among them,40 cases with abnormal CT findings. To predict severe CT changes after acute phase with the NSE level 45.7 ng ~ mL-lat the 2nd days after birth, the sensitivity and specifity were 71.4% and 88.3% , respectively. Conclusion The serum NSE levels were related to the intracranial morphological changes in HIE cases.