缺氧缺血性脑病血和脑脊液LDH、CK及同工酶分析和相关性研究

目的　探讨不同程度缺氧缺血性脑病（ＨＩＥ） 新生儿血清乳酸脱氢酶（ＬＤＨ） 、肌酸激酶（ＣＫ）和同工酶活性变化及与脑脊液酶活性的相关性。　方法　４７ 例轻、中、重度ＨＩＥ 和３９ 例正常儿均于生后４８ 小时内进行血清ＬＤＨ 及同工酶ＬＤＨ１，２，３，４，５ 、ＣＫ 及同工酶ＣＫＭＭ，ＣＫＭＢ和ＣＫＢＢ活性检测。其中２４ 例患儿同时作血清和脑脊液酶活性的相关性分析。　结果　ＨＩＥ中度和重度组血清ＬＤＨ、ＣＫ、ＬＤＨ３ ，４，５ 和ＣＫＢＢ活性明显高于正常组和轻度组（Ｐ＜ ０．０５），以ＬＤＨ３ 升高为著（ Ｐ＜０．０１）。血清和脑脊液ＬＤＨ３ ，４，５ 、ＣＫ 和ＣＫＢＢ活性呈良好正相关（ Ｐ＜ ０．０５），其中ＣＫＢＢ 呈高度正相关（ Ｐ＜ ０ ．０１） 。　结论　血清ＬＤＨ、ＣＫ 和同工酶，尤其ＣＫＢＢ、ＬＤＨ３ 活性测定可代替脑脊液酶活性的检查，可作为缺氧缺血性脑损伤及程度评价的参考指标。

Study on LDH,CK and Their Isoenzymes in Serum and CSF in Neonates with HIE and Their Correlation

Objective To explore the changes of lactic dehydrogenase (LDH),creatine kinase(CK) and isoenzymes activities in neonates with hypoxic ischemic encephalopathy(HIE) and to observe the correlations between enzyme values in serum and CSF as to provide lab evidence for diagnostic assessment of HIE. Methods 47 patients with HIE(including mild 15,moderate 15,severe 16)and 39 normal neonates(control group) were involved in the experiments.Serum enzymes were studied from all neonates in both case and control groups,and serum and CSF enzymes analyzed in 24 neonates with HIE. Results The activities of serum LDH,CK and isoenzymes increased gradually with the severity of the disease.The activities of serum LDH,CK and LDH 3,4,5 ,CK BB in moderate and severe HIE were significantly higher than those in mild and control group( P <0.05),particularly LDH 3( P <0.01).LDH 1,2 ,CK MM and CK MB only in severe HIE were evidently higher than mild and control group ( P <0.01).CK and LDH 3,4,5 and CK BB activities in serum were positively correlated with those in CSF in 24 patients with HIE,particularly CK BB activity( P <0.01). Conclusion The study suggested that it is likely that serum LDH,CK and isoenzymes concentrations are related to the severity of brain injury and the measurement of serum LDH,CK and isoenzymes,especially LDH 3,CK BB in patients with HIE may be useful for assessing brain damage and could be substituted for those in cerebrospinal fluid.