摘要
目的探讨高胆红素血症新生儿脑脊液神经元特异性烯醇化酶(NSE)及胆红素水平变化与其远期神经发育的关系。方法选择2015年1月至2017年1月湖北民族大学附属民大医院新生儿科收治且符合临床诊断标准的高胆红素血症新生儿120例纳入观察组,同时选择同期于湖北民族大学附属民大医院产科足月顺产的健康新生儿108例纳入对照组。采集空腹静脉血2 mL和经腰穿或引流管采集脑脊液标本2 mL,采用流式荧光法(ECLIA)检测脑脊液NSE水平及全自动生化检查分析仪对血清总胆红素(TBIL)水平进行检测,比较两组新生儿脑脊液NSE及总胆红素水平。运用贝利婴幼儿发展量表第2版(BSID-Ⅱ)在纠正胎龄18个月时对患儿进行测试神经发育检查,评估两组新生儿远期神经发育情况。结果入院24 h观察组脑脊液NSE水平为(22.90±4.18)μg/L,TBIL水平为(176.23±24.56)μmol/L;入院72 h时上述指标达到峰值,NSE为(37.87±6.89)μg/L,TBIL为(275.16±40.23)μmol/L;出院时上述指标均下降,NSE为(15.80±3.45)μg/L,TBIL为(87.36±18.90)μmol/L;与同时间点的对照组比较,差异均有统计学意义(P<0.05)。根据TBIL水平将观察组分为TBIL高、中、低水平组,TBIL水平分别为(50.18±9.03)μg/L、(42.23±6.70)μg/L、(24.34±3.18)μg/L,智能发育指数(MDI)评分分别为(60.15±3.78)分、(70.24±4.15)分、(83.34±5.67)分,运动发育指数(PDI)评分分别为(65.45±5.93)分、(76.23±8.90)分、(84.56±9.07)分,组间比较差异均有统计学意义(P<0.05)。相关性分析显示,入院72 h时患儿脑脊液NSE与MDI和PDI评分均呈负相关(r=-0.859、-0.810,P<0.05)。结论脑脊液NSE水平可作为高胆红素血症新生儿远期神经发育的预测指标。
Objective To investigate the relationship between neuronal-specific enolase(NSE)and bilirubin levels in neonatal cerebrospinal fluid and its long-term neurodevelopment.Methods 120 patients with hyperbilirubinemia who met the clinical diagnostic criteria admitted to the neonatal intensive care unit of Minda Hospital affiliated to Hubei University for Nationalities from January 2015 to January 2017 were enrolled in the observation group.108 healthy newborns born in the obstetrics department of the National People′s Congress Hospital were included in the control group.2 mL of fasting venous blood and 2 mL of cerebrospinal fluid specimens were collected through a lumbar puncture or drainage tube.Flow fluorimetry(ECLIA)was used to detect the level of NSE in cerebrospinal fluid and the automatic biochemical examination analyzer was used to detect serum total bilirubin level.The second edition of the Bailey Infant Development Scale(BSID-II)was used to evaluate the neurodevelopmental.Results At 24 hours after admission,the NSE level was(22.90±4.18)μg/L and TBIL level was(176.23±24.56)μmol/L in the cerebrospinal fluid of the observation group.At the 72 h after admission,the above indicators reached the peak,which was(37.87±6.89)μg/L of the NSE level and(275.16±40.23)μmol/L of the TBIL level.The above indicators decreased at the time of discharge,which was(15.80±3.45)μg/L of the NSE level and(87.36±18.90)μmol/L of the TBIL level.There were statistically significant differences between the NSE and TBIL levels of observation group and those of the control group at the same time point(P<0.05).Correlation analysis showed that NSE was negatively correlated with MDI and PDI scores at 72 hours after admission(r=-0.859,-0.810,P<0.05).Conclusion NSE levels in cerebrospinal fluid could be used as a predictor of long-term neurodevelopment in neonates with hyperbilirubinemia.
作者
刘兆敏
李丽
向垚林
谭美娟
向茂艳
LIU Zhao min;LI Li;XIANG Yao lin;TAN Mei juan;XIANG Mao yan(Department of Neonatology,Affiliated Minda Hospital of Hubei Institute for Nationalities,Enshi,Hubei 445000;Department of Obstetrics,Affiliated Minda Hospital of Hubei Institute for Nationalities,Enshi,Hubei 445000,China)
出处
《热带医学杂志》
CAS
2019年第6期747-750,共4页
Journal of Tropical Medicine
基金
恩施州指导性科研项目(恩州科业【2018】19号-8).
