神经元特异性烯醇化酶及血清γ-GT在诊断新生儿胆红素脑病中的价值
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摘要
目的:探究血清神经元特异性烯醇化酶(NSE)、γ-谷氨酰转肽酶(γ-GT)对新生儿胆红素脑病(NBE)的临床诊断价值。方法:选取2014年3月至2018年9月本院收治的新生儿高胆红素血症患儿340例,其中NBE患儿108例为研究组,非NBE患儿232例为对照组。观察两组血清总胆红素(TBIL)、间接胆红素(IBIL)、NSE、γ-GT水平;分析TBIL、IBIL与NSE、γ-GT的相关性;评估NSE、γ-GT及二者联合诊断NBE的价值。结果:研究组血清TBIL、IBIL、NSE、γ-GT水平均高于对照组,差异有统计学意义(P<0.05)。相关分析显示TBIL、IBIL与NSE、γ-GT水平均呈正相关(P<0.05);NSE与γ-GT亦呈正相关(P<0.05)。ROC曲线分析得出血清NSE、γ-GT及二者联合诊断的曲线下面积(AUC)分别为0.876、0.825、0.890;在最佳临界值点对应的灵敏度、特异度分别为:NSE 72.2%、93.1%,γ-GT 72.2%、85.3%,二者联合为82.4%、84.9%;其中二者联合的诊断效能高于单项诊断。结论:血清NSE、γ-GT对NBE均具有诊断价值,且NSE优于γ-GT,而二者联合的诊断效能最高,可为NBE早期辅助评估提供客观参考。
Objective: To investigate the clinical value of serum neuron specific enolase(NSE) and γ-glutamyltranspeptidase(γ-GT) in the diagnosis of neonatal bilirubin encephalopathy(NBE). Methods: A total of 340 children with neonatal hyperbilirubinemia admitted to our hospital from March 2014 to September 2018 were enrolled. Among them, 108 patients with NBE were in the study group and 232 patients with non-NBE were in the control group. The serum levels of total bilirubin(TBIL), indirect bilirubin(IBIL), NSE, and γ-GT were observed. To analyze the correlation between TBIL, IBIL and NSE, γ-GT; to evaluate the value of NSE, γ-GT and their combined diagnosis of NBE. Results: The serum levels of TBIL, IBIL, NSE and γ-GT in the study group were higher than those in the control group, and the difference was statistically significant(P<0.05). Correlation analysis showed that TBIL and IBIL were positively correlated with NSE and γ-GT levels(P<0.05); NSE was also positively correlated with γ-GT(P<0.05). ROC curve analysis showed that the area under the curve(AUC) of serum NSE, γ-GT and the combined diagnosis of the two were 0.876, 0.825, 0.890; The sensitivity and specificity corresponding to the optimal threshold point were: NSE 72.2%, 93.1%, γ-GT 72.2%, 85.3%, and the combined diagnosis was 82.4% and 84.9%; The combined diagnostic efficacy of the two is higher than the single diagnosis. Conclusion: Serum NSE and γ-GT have diagnostic value for NBE, and NSE is superior to γ-GT, and the combination of the two has the highest diagnostic efficiency, which can provide an objective reference for early auxiliary evaluation of NBE.
Objective: To investigate the clinical value of serum neuron specific enolase(NSE) and γ-glutamyltranspeptidase(γ-GT) in the diagnosis of neonatal bilirubin encephalopathy(NBE). Methods: A total of 340 children with neonatal hyperbilirubinemia admitted to our hospital from March 2014 to September 2018 were enrolled. Among them, 108 patients with NBE were in the study group and 232 patients with non-NBE were in the control group. The serum levels of total bilirubin(TBIL), indirect bilirubin(IBIL), NSE, and γ-GT were observed. To analyze the correlation between TBIL, IBIL and NSE, γ-GT; to evaluate the value of NSE, γ-GT and their combined diagnosis of NBE. Results: The serum levels of TBIL, IBIL, NSE and γ-GT in the study group were higher than those in the control group, and the difference was statistically significant(P<0.05). Correlation analysis showed that TBIL and IBIL were positively correlated with NSE and γ-GT levels(P<0.05); NSE was also positively correlated with γ-GT(P<0.05). ROC curve analysis showed that the area under the curve(AUC) of serum NSE, γ-GT and the combined diagnosis of the two were 0.876, 0.825, 0.890; The sensitivity and specificity corresponding to the optimal threshold point were: NSE 72.2%, 93.1%, γ-GT 72.2%, 85.3%, and the combined diagnosis was 82.4% and 84.9%; The combined diagnostic efficacy of the two is higher than the single diagnosis. Conclusion: Serum NSE and γ-GT have diagnostic value for NBE, and NSE is superior to γ-GT, and the combination of the two has the highest diagnostic efficiency, which can provide an objective reference for early auxiliary evaluation of NBE.
引文
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[9] 舒桂华,徐翔,梁琪,等.γ-谷氨酰转肽酶在足月新生儿高未结合胆红素神经毒性早期评估中的应用[J].中国临床实用医学,2015,6(6):20～23.
[10] 邱建武,刁诗光,刘晓燕,等.新生儿胆红素脑病监测NSE的意义[J].中国妇幼健康研究,2016,27(12):1445～1446.
[11] Shimy M S E,Elraggal N M,Elfarrash R A,et al.Cerebral blood flow and serum neuron-specific enolase in early-onset neonatal sepsis[J].Pediatric Research,2018,84(2):261～266.
[2] 陈海江,丁杰锋,杨旦,等.孕妇产前抗A(B)IgG效价对高胆红素血症新生儿的影响研究[J].浙江医学,2016,38(5):336～338.
[3] 高金萍,王琨.脑脊液胆红素、头颅MRI、BAEP及NBNA在新生儿胆红素脑病早期诊断中的价值[J].现代中西医结合杂志,2016,25(29):3279～3281.
[4] 李登云.手足口病合并脑炎患儿血清和脑脊液肿瘤坏死因子α、神经元特异性烯醇化酶和S100B蛋白水平检测及其临床意义[J].中国基层医药,2016,23(2):229～232.
[5] 吴玉丽,赵晓莉,王游,等.血清NSE水平联合头颅MRI检查在新生儿高胆红素血症脑损伤评价中的价值[J].河北医学,2016,22(9):1493～1495.
[6] 李惠芳,刘庚.神经元特异性烯醇化酶及S100β蛋白在颅内感染及脑组织损伤评估中的临床意义[J].四川医学,2017,38(3):335～337.
[7] 付慧,熊虹,康文清.血清S100蛋白及神经元烯醇化酶在新生儿胆红素脑病中表达及意义[J].中华实用诊断与治疗杂志,2018,32(7):676～677.
[8] Wiener C D,Molina M L,Passos M,et al.Neuron-specific enolase levels in drug-naive young adults with major depressive disorder.[J].Neuroscience Letters,2016,620(1):93～96.
[9] 舒桂华,徐翔,梁琪,等.γ-谷氨酰转肽酶在足月新生儿高未结合胆红素神经毒性早期评估中的应用[J].中国临床实用医学,2015,6(6):20～23.
[10] 邱建武,刁诗光,刘晓燕,等.新生儿胆红素脑病监测NSE的意义[J].中国妇幼健康研究,2016,27(12):1445～1446.
[11] Shimy M S E,Elraggal N M,Elfarrash R A,et al.Cerebral blood flow and serum neuron-specific enolase in early-onset neonatal sepsis[J].Pediatric Research,2018,84(2):261～266.