脑脊液超敏C反应蛋白与新生儿脑室内出血继发脑积水的关系
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摘要
目的探讨脑脊液超敏C-反应蛋白(hs-CRP)与新生儿脑室内出血继发脑积水的关系。方法纳入37例脑室内出血患儿,根据脑积水的发生情况分为脑积水组15例及非脑积水组22例。比较两组患儿的脑脊液hs-CRP水平。采用受试者工作特征(ROC)曲线分析脑脊液hs-CRP水平预测新生儿脑室内出血继发脑积水的价值。分析脑积水组患儿脑脊液hs-CRP水平与Evans指数的相关性。结果脑积水组患儿脑脊液hs-CRP水平为[2. 33(2. 01,3. 08)]mg/L,高于非脑积水组的[0. 44(0. 35,0. 53)]mg/L(P <0. 05)。Hs-CRP水平预测脑室内出血新生儿继发脑积水的ROC曲线下面积为0. 861(P <0. 05)。脑积水患儿脑脊液hs-CRP水平与Evans指数呈正相关性(P <0. 05)。结论脑脊液hs-CRP水平升高可能与新生儿脑室内出血继发脑积水有关,对新生儿脑室内出血继发脑积水的诊断及病情评估有重要意义。
Objective To explore the relationship between cerebrospinal fluid hypersensitive C-reactive protein( hs-CRP) and hydrocephalus secondary to intraventricular hemorrhage in neonates. Methods Thirty-seven children with intraventricular hemorrhage were enrolled and divided into hydrocephalus group( 15 cases) or non-hydrocephalus group( 22 cases) according to the occurrence of hydrocephalus. The level of hs-CRP in cerebrospinal fluid was compared between the two groups,and its value in predicting hydrocephalus secondary to neonatal intraventricular hemorrhage was analyzed by receiver operating characteristic( ROC) curve. The correlation between hs-CRP level in cerebrospinal fluid and Evans index in hydrocephalus group was analyzed. Results The hs-CRP level in cerebrospinal fluid was higher in the hydrocephalus group than in the non-hydrocephalus group{[2. 33( 2. 01,3. 08) ]mg/L vs. [0. 44( 0. 35,0. 53) ]mg/L,P <0. 05}. The area under the ROC curve of hs-CRP predicting secondary hydrocephalus in neonates with intraventricular hemorrhage was 0. 861( P <0.05). There was a positive correlation between hs-CRP level in cerebrospinal fluid and Evans index in neonates with hydrocephalus( P < 0. 05). Conclusion The increasement of hs-CRP level in cerebrospinal fluid may be related to hydrocephalus secondary to neonatal intraventricular hemorrhage,which is of great significance for the diagnosis and evaluation of hydrocephalus secondary to neonatal intraventricular hemorrhage.
Objective To explore the relationship between cerebrospinal fluid hypersensitive C-reactive protein( hs-CRP) and hydrocephalus secondary to intraventricular hemorrhage in neonates. Methods Thirty-seven children with intraventricular hemorrhage were enrolled and divided into hydrocephalus group( 15 cases) or non-hydrocephalus group( 22 cases) according to the occurrence of hydrocephalus. The level of hs-CRP in cerebrospinal fluid was compared between the two groups,and its value in predicting hydrocephalus secondary to neonatal intraventricular hemorrhage was analyzed by receiver operating characteristic( ROC) curve. The correlation between hs-CRP level in cerebrospinal fluid and Evans index in hydrocephalus group was analyzed. Results The hs-CRP level in cerebrospinal fluid was higher in the hydrocephalus group than in the non-hydrocephalus group{[2. 33( 2. 01,3. 08) ]mg/L vs. [0. 44( 0. 35,0. 53) ]mg/L,P <0. 05}. The area under the ROC curve of hs-CRP predicting secondary hydrocephalus in neonates with intraventricular hemorrhage was 0. 861( P <0.05). There was a positive correlation between hs-CRP level in cerebrospinal fluid and Evans index in neonates with hydrocephalus( P < 0. 05). Conclusion The increasement of hs-CRP level in cerebrospinal fluid may be related to hydrocephalus secondary to neonatal intraventricular hemorrhage,which is of great significance for the diagnosis and evaluation of hydrocephalus secondary to neonatal intraventricular hemorrhage.
引文
[1]陈惠金,吴圣楣.早产儿脑室内出血的早期诊断和防治[J].中华儿科杂志,2003,41(2):110-112.
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[7]Papile LA,Burstein J,Burstein R,et al. Incidence and evaluation of subependymal and intraventricular hemorrhage:a study of infants with birth weightless than 1,500 gm[J]. J Pediatr,1978,92(4):529-534.
[8]Miller S,Ferriero D,Barkovich AJ,et al. Practice parameter:neuroimaging of the neonate:report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society[J].Neurology,2002,59(10):1 663.
[9]中国医师协会神经外科医师分会.中国脑积水规范化治疗专家共识(2013版)[J].中华神经外科杂志,2013,29(6):634-637.
[10]Braun A,Xu H,Hu F,et al. Paucity of pericytes in germinal matrix vasculature of premature infants[J]. J Neurosci,2007,27(44):12 012-12 024.
[11]Behjati S,Emami-Naeini P,Nejat F,et al. Incidence of hydrocephalus and the need to ventriculoperitoneal shunting in premature infants with intraventricular hemorrhage:risk factors and outcome[J]. Childs Nerv Syst,2011,27(6):985-989.
[12]Strahle J,Garton HJ,Maher CO,et al. Mechanisms of hydrocephalus after neonatal and adult intraventricular hemorrhage[J]. Transl Stroke Res,2012,3(Suppl 1):25-38.
[13]Lim WH,Lien R,Chiang MC,et al. Hypernatremia and gradeⅢ/Ⅳintraventricular hemorrhage among extremely low birth weight infants[J]. J Perinatol,2011,31(3):193-198.
[14]Zhang J,Williams MA,Rigamonti D. Genetics of human hydrocephalus[J]. J Neurol,2006,253(10):1 255-1 266.
[15]Cherian S,Whitelaw A,Thoresen M,et al. The pathogenesis of neonatal post-hemorrhagic hydrocephalus[J]. Brain Pathol,2006,14(3):305-311.
[16]周志宇,韦成聪,赵冠焱,等.颅脑损伤后脑脊液C反应蛋白动态变化及临床意义[J].中华实用诊断与治疗杂志,2013,27(2):118-120,123.
[17]Savman K,Blennow M,Hagberg H,et al. Cytokine response in cerebrospinal fluid from preterm infants with posthaemorrhagic ventricular dilatation[J]. Acta Paediatr,2002,91(12):1 357-1 363.
[2]陈惠金.早产儿脑室内出血的药物预防和出血后脑积水的治疗[J].中国新生儿科杂志,2009,24(6):321-323.
[3]Karimy JK,Duran D,Hu JK,et al. Cerebrospinal fluid hypersecretion in pediatric hydrocephalus[J]. Neurosurg Focus,2016,41(5):E10.
[4]Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity:pathophysiology and current treatment concepts[J]. J Neurosurg Pediatr,2012,9(3):242-258.
[5]Andrikopoulou M,Almalki A,Farzin A,et al. Perinatal biomarkers in prematurity:early identification of neurologic injury[J]. Int J Dev Neurosci,2014,36:25-31.
[6]许绍强.超敏C反应蛋白在颅脑疾病中的应用价值[J].现代医院,2007,7(11):20-22.
[7]Papile LA,Burstein J,Burstein R,et al. Incidence and evaluation of subependymal and intraventricular hemorrhage:a study of infants with birth weightless than 1,500 gm[J]. J Pediatr,1978,92(4):529-534.
[8]Miller S,Ferriero D,Barkovich AJ,et al. Practice parameter:neuroimaging of the neonate:report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society[J].Neurology,2002,59(10):1 663.
[9]中国医师协会神经外科医师分会.中国脑积水规范化治疗专家共识(2013版)[J].中华神经外科杂志,2013,29(6):634-637.
[10]Braun A,Xu H,Hu F,et al. Paucity of pericytes in germinal matrix vasculature of premature infants[J]. J Neurosci,2007,27(44):12 012-12 024.
[11]Behjati S,Emami-Naeini P,Nejat F,et al. Incidence of hydrocephalus and the need to ventriculoperitoneal shunting in premature infants with intraventricular hemorrhage:risk factors and outcome[J]. Childs Nerv Syst,2011,27(6):985-989.
[12]Strahle J,Garton HJ,Maher CO,et al. Mechanisms of hydrocephalus after neonatal and adult intraventricular hemorrhage[J]. Transl Stroke Res,2012,3(Suppl 1):25-38.
[13]Lim WH,Lien R,Chiang MC,et al. Hypernatremia and gradeⅢ/Ⅳintraventricular hemorrhage among extremely low birth weight infants[J]. J Perinatol,2011,31(3):193-198.
[14]Zhang J,Williams MA,Rigamonti D. Genetics of human hydrocephalus[J]. J Neurol,2006,253(10):1 255-1 266.
[15]Cherian S,Whitelaw A,Thoresen M,et al. The pathogenesis of neonatal post-hemorrhagic hydrocephalus[J]. Brain Pathol,2006,14(3):305-311.
[16]周志宇,韦成聪,赵冠焱,等.颅脑损伤后脑脊液C反应蛋白动态变化及临床意义[J].中华实用诊断与治疗杂志,2013,27(2):118-120,123.
[17]Savman K,Blennow M,Hagberg H,et al. Cytokine response in cerebrospinal fluid from preterm infants with posthaemorrhagic ventricular dilatation[J]. Acta Paediatr,2002,91(12):1 357-1 363.