摘要
目的探讨脑脊液(CSF)中胱抑素C(Cys-C)水平对新生儿窒息后脑损伤的诊断价值。方法选择我院新生儿科2010年12月—2011年12月收治的窒息新生儿25例,根据Apgar评分标准分为重度窒息组12例(1min Apgar评分0～3分),轻度窒息组13例(1 min Apgar评分4～7分)。另选取同时期无窒息及宫内窘迫而疑为中枢神经系统感染行CSF检查予以排除且无其他异常者11例为对照组。于生后36～72 h取CSF和血液,采用乳胶增强免疫比浊法测定Cys-C水平。出院患儿于半岁、1岁时随访,由专人运用贝利婴幼儿发展量表(BSID)测定其智力发展指数(MDI)及精神运动发展指数(PDI)。结果对照组、轻度窒息组和重度窒息组CSF、血清中Cys-C水平比较,差异均有统计学意义(P<0.05);其中轻、重度窒息组CSF中Cys-C水平低于对照组,血清中Cys-C水平高于对照组,差异均有统计学意义(P<0.05);重度窒息组CSF中Cys-C水平低于轻度窒息组,血清中Cys-C水平高于轻度窒息组,差异均有统计学意义(P<0.05)。重度窒息组12例中,3例死亡,9例存活,生后12～14 d新生儿行为神经测定(NBNA)评分低于对照组和轻度窒息组,轻度窒息组NBNA评分亦低于对照组,差异均有统计学意义(P<0.05)。6～12个月后重度窒息组MDI、PDI低于轻度窒息组和对照组,轻度窒息组MDI和PDI低于对照组,差异均有统计学意义(P<0.05)。无一例出现脑性瘫痪及智力障碍。相关性分析显示,CSF中Cys-C水平与MDI和PDI呈正相关(r值分别为0.623和0.786,P<0.05)。结论 CSF中Cys-C水平与窒息新生儿脑损伤关系密切,可作为新生儿窒息后早期评估脑损伤和评价预后的敏感指标之一。
Objective To investigate the value of cerebrospinal fluid（CSF） concentration of cystatin C（Cys-C） in the diagnosis of neonatal brain injury caused by asphyxia.Methods Thirty-six neonates treated in our hospital between December 2010 and December 2011 were divided into the severe asphyxia group（1 min Apgar score 0～3,n = 12）,mild asphyxia group（4～7,n = 13）,and the control group（n = 11）.CSF and blood was drawn 36～72 h after birth and Cys-C level was measured by latex enhanced immune turbidimetric method.The subjects were followed up at half a year old and one year old to measure their mental development index（MDI） and psychomotor development index（PDI） using the Bailey scales of infant development（BSID）.Results The severe and mild asphyxia groups had lower CSF Cys-C levels but higher serum Cys-C levels than the control group（P〈 0.05）.The severe asphyxia group had lower CSF Cys-C level but higher serum Cys-C level than the mild asphyxia group（P〈 0.05）.Nine out of 12 children in the severe asphyxia group survived,but their neonatal behavioral neurological assessment（NBNA） score at d 12～14 was lower than that of the control group and the mild asphyxia group（P〈 0.05）;The NBNA score of the mild asphyxia group was lower than that of the control group（P〈 0.05）.After 6 to 12 months,MDI and PDI of the severe asphyxia group were significantly lower than that of the mild asphyxia group and the control group（P〈 0.05）;MDI and PDI of the mild asphyxia group were significantly lower than that of the control group（P〈 0.05）.No case of cerebral palsy or mental retardation was observed.Correlation analysis showed that CSF Cys-C level was positively correlated with MDI and PDI（r = 0.623,0.786,P〈 0.05）.Conclusion CSF Cys-C level is closely related with newborn brain injury caused by asphyxia,therefore can be used as an indicator for early assessment of brain injury after neonatal asphyxia and prognosis.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第20期2389-2391,共3页
Chinese General Practice
关键词
窒息
新生儿
脑脊液
胱抑素C
脑损伤
Asphyxia
neonatorum
Cerebrospinal fluid
Cystatin C
Brain injuries
