摘要
目的探讨激活素A(ACTA)、S-100B蛋白及胶质纤维酸性蛋白(GFAP)水平对新生儿缺氧缺血性脑病(HIE)预后评估的价值.方法选取海南医学院第二附属医院收治的HIE患儿124例,根据其预后情况分成存活组(n=93)和死亡组(n=31).采用神经症状临床分度分为轻-中度组86例和重度组38例,比较各组第1、3、7天血清ACTA、S-100B蛋白及GFAP水平变化.应用受试者工作特征曲线(ROC)分析血清ACTA、S-100B蛋白及GFAP水平,及其对预测HIE患儿死亡的价值.结果死亡组第1、3、7天血清ACTA(ng/L:78.62±10.83 vs.63.50±9.14,92.35±13.62 vs.70.24±10.16,108.58±17.40 vs.67.52±9.70)、S-100B蛋白(μg/L:3.60±1.06 vs.2.28±0.61,4.90±1.38 vs.3.22±0.87,6.50±1.83 vs.3.06±0.82)及GFAP(ng/L:150.36±43.68 vs.102.40±31.26,184.35±52.70 vs.118.27±33.90,224.62±63.50 vs.112.85±32.14)均明显高于存活组(P<0.05).重度组第1、3、7天血清ACTA(ng/L:75.80±10.83vs.66.53±9.42,89.70±13.15 vs.74.20±10.63,104.90±16.38 vs.70.62±10.27)、S-100B蛋白(μg/L:3.46±1.02 vs.2.42±0.65,4.72±1.30 vs.3.32±0.93,6.35±1.72 vs.3.20±0.84)及GFAP(ng/L:142.70±40.25 vs.110.50±33.28,170.52±48.27 vs.128.30±36.45,210.53±60.27 vs.122.60±33.74)均明显高于轻-中度组(P<0.05).ROC曲线显示,第3天血清ACTA、S-100B蛋白联合GFAP预测HIE患儿死亡的ROC曲线下面积最大,其敏感度和特异度为96.2%和90.3%.相关分析显示,死亡组血清ACTA与S-100B及GFAP水平均呈正相关(r=0.784,r=0.837,P<0.01).结论血清ACTA、S-100B蛋白及GFAP水平升高与HIE患儿的病情严重程度相关,第3天三项联合检测对HIE患儿预后评估的价值较高.
Objective To evaluate the prognostic value of activin A(ACTA),S-100B protein and glial fibrillary acidic protein(GFAP)levels in neonatal hypoxic-ischemic encephalopathy(HIE).Methods 124 children with HIE admitted to the Second Affiliated Hospital of Hainan Medical College were divided into survival group(n=93)and dead group(n=31)according to their prognosis,and were divided into mild-moderate group(n=86 cases)and severe group(n=38 ca ses)according to clinical classification of neurological symptoms.Serum levels of ACTA,S-100B protein and GFAP levels in each group were compared on the first,third and seventh day.The value of serum ACTA,S100B protein and GFAP levels in predicting death of the children with HIE were analyzed by ROC curve.Results The serum levels of ACTA(ng/L:78.62±10.83 vs.63.50±9.14,92.35±13.62 vs.70.24±10.16,108.58±17.40 vs.67.52±9.70),S-100 B protein(A g/L:3.60±1.06 vs.2.28±0.61,4.90±1.38 vs.3.22±0.87,6.50±1.83 vs.3.06±0.82)and GFA P(ng/L:150.36±43.68 vs.102.40±31.26,184.35±52.70 vs.118.27±33.90,224.62±63.50 vs.112.85±32.14)on the first,third,seventh day in the dead group were significantly higher than those in the survival group(P〈O.O5).The serum levels of ACTA(ng/L:75.80±10.83 vs.66.53±9.42,89.70±13.15 vs.74.20±10.63,104.90±16.38 vs.70.62±10.27),S-100B protein(μg/L:3.46±1.02 vs.2.42±0.65,4.72±1.30 v s.3.32±0.93,6.35±1.72 vs.3.20±0.84)and GFA P(ng/L:142.70±40.25 vs.110.50±33.28,170.52±48.27 vs.128.30±36.45,210.53±60.27 vs.122.60±33.74)in severe group were significantly higher than those in mild-moderate group on the first,third and seventh day(P<0.05).ROC curve showed that the area under the curve of predicting death in HIE children with serum ACTA,S-100B protein combined with GFAP level on the third day was the largest,and its sensitivity and specificity were 96.2%and 90.3%.The correlation analysis showed that serum ACTA was positively correlated with S-100B and GFAP levels in the dead group(r=0.784,r=0.837,P<0.01).Conclusion The increase of serum ACTA,S-100B protein and GFAP level are related to the severity of HIE childrens disease,and three combined tests on the third day have a high value in the prognosis assessment of HIE children.
作者
古裕鸟
霍开明
庄秀娟
蒋家敏
吴小红
黄旭芳
Gu Yu-niao;Huo Kai-ming;Zhuang Xiu-juan;Jiang Jia-min;Wu Xiao-hong;Huang Xu-fang(Department of Pediatrics,the Second Affiliated Hospital of Hainan Medical College,Haikou 571700,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2020年第2期132-136,共5页
Chinese Journal of Critical Care Medicine
