新生儿血液样本溶血对血清NSE检测结果的影响及其校正公式的建立
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摘要
目的探讨新生儿血液样本溶血对血清神经元特异性烯醇化酶(NSE)检测结果的影响,并建立其校正公式。方法在72份出生24 h内的新生儿血清样本中添加对应的冻融红细胞。采用化学发光法检测添加前后血清NSE浓度的变化,氰化高铁血红蛋白(HiCN)法检测添加前后血清血红蛋白(Hb)浓度的变化,从而建立新生儿溶血样本的NSE校正公式。根据自身Hb变化对NSE结果的影响推算出变化常数。将变化常数校正的NSE结果与HiCN法校正公式校正的NSE结果进行比较,评价HiCN法校正公式的可行性。对HiCN法与仪器法的Hb检测结果进行相关性分析,以建立针对仪器法的NSE校正公式。结果 72份新生儿溶血样本NSE浓度结果变化常数为(23.70±3.62)mg/g Hb。以ΔNSE_(血清)为Y、ΔHb_(HiCN)为X,血清NSE浓度变化与Hb浓度变化之间的相关方程为Y=23.17X(r~2=0.8122,P<0.001)。采用自身变化常数获得的NSE校正值和采用相关方程获得的NSE校正值之间差异无统计学意义(P=0.541)。HiCN法与仪器法的Hb结果高度相关(r~2=0.992 4,P<0.001)。HiCN法和仪器法新生儿血清NSE检测结果的校正公式分别为NSE_(校正)=NSE_(测定)-23.17Hb_(HiCN)和NSE_(校正)=NSE_(测定)-23.60Hb_(仪器)+13.22。结论溶血对血清NSE检测影响较大。可以通过校正公式计算新生儿溶血样本NSE浓度,以帮助临床评价新生儿缺氧缺血性脑病(HIE)的严重程度。
Objective To evaluate the influence of neonatal blood sample hemolysis on the determination of serum neuron-specific enolase(NSE),and to establish correction equation. Methods Chemiluminescence was used to determine the change of serum NSE level before and after adding self-frozen thawed red blood cells in 72 neonates borned less than 24 h. The changes of hemoglobin(Hb) before and after adding were determined by cyanmethemoglobin(HiCN). The correction equation was established. The feasibility of correction equation was evaluated by comparing the NSE results with the NSE results corrected by self-constant and the correction equation. The NSE correction equation for instrumental method was established by analyzing the correlation of Hb results determined by HiCN method and instrumental method. Results The change constants of NSE in 72 neonates with serum hemolysis was(23.70 ±3.62) mg/g Hb. The relationship of concentration variation between Hb and NSE in neonatal bloodsample was ΔNSE_(serum)=23.17×ΔHb_(HiCN)(Y=23.17 X,r~2=0.812 2,P<0.001). There was no statistical significance of NSE corrected results between self-constant group and correction equation group(P=0.541). The linearity for Hb of instrumental method with HiCN was high(r~2=0.992 4,P<0.001). The correction equations of NSE in neonatal hemolytic serum were NSE_(correction)=NSE_(measurement)-23.17 Hb_(HiCN) and NSE_(correction)=NSE_(measurement)-23.60 Hb_(instrument)+13.22. Conclusions Hemolysis has a serious influence on the determination of NSE in serum. For neonatal hemolytic sera,it is critical to evaluate the severity of neonatal hypoxic ischemic encephalopathy by correcting NSE level.
Objective To evaluate the influence of neonatal blood sample hemolysis on the determination of serum neuron-specific enolase(NSE),and to establish correction equation. Methods Chemiluminescence was used to determine the change of serum NSE level before and after adding self-frozen thawed red blood cells in 72 neonates borned less than 24 h. The changes of hemoglobin(Hb) before and after adding were determined by cyanmethemoglobin(HiCN). The correction equation was established. The feasibility of correction equation was evaluated by comparing the NSE results with the NSE results corrected by self-constant and the correction equation. The NSE correction equation for instrumental method was established by analyzing the correlation of Hb results determined by HiCN method and instrumental method. Results The change constants of NSE in 72 neonates with serum hemolysis was(23.70 ±3.62) mg/g Hb. The relationship of concentration variation between Hb and NSE in neonatal bloodsample was ΔNSE_(serum)=23.17×ΔHb_(HiCN)(Y=23.17 X,r~2=0.812 2,P<0.001). There was no statistical significance of NSE corrected results between self-constant group and correction equation group(P=0.541). The linearity for Hb of instrumental method with HiCN was high(r~2=0.992 4,P<0.001). The correction equations of NSE in neonatal hemolytic serum were NSE_(correction)=NSE_(measurement)-23.17 Hb_(HiCN) and NSE_(correction)=NSE_(measurement)-23.60 Hb_(instrument)+13.22. Conclusions Hemolysis has a serious influence on the determination of NSE in serum. For neonatal hemolytic sera,it is critical to evaluate the severity of neonatal hypoxic ischemic encephalopathy by correcting NSE level.
引文
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[6]GUZEL A,ER U,TATLI M,et al.Serum neuronspecific enolase as a predictor of short-term outcome and its correlation with Glasgow Coma Scale in traumatic brain injury[J].Neurosurg Rev,2008,31(4):439-444.
[7]CHABOK S Y,MOGHADAM A D,SANEEI Z,et al.Neuron-specific enolase and S100BB as outcome predictors in severe diffuse axonal injury[J].J Trauma Acute Care Surg,2012,72(6):1654-1657.
[8]CELTIK C,ACUNAS B,ONER N,et al.Neuron-specific enolase as a marker of the severity and outcome of hypoxic ischemic encephalopathy[J].Brain Dev,2004,26(6):398-402.
[9]National Committee for Clinical Laboratory Standards.Method comparison and bias estimation using patient samples[S].EP9-A2,NCCLS,2002.
[10]TOLAN N V,VIDAL-FOLCH N,ALGECIRAS-SCHIMNICH A,et al.Individualized correction of neuronspecific enolase(NSE)measurement in hemolyzed serum samples[J].Clin Chim Acta,2013,424:216-221.
[11]GULCZYNSKA E,GADZINOWSK I J.Therapeut ic hypothermia for neonatal hypoxic-ischemic encephalopathy[J].Ginekol Pol,2012,83(3):214-218.
[12]HORN A R,S WINGLER G H,MYER L,et al.Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours[J].BMC Pediatr,2013,13:52.2018-04-19
[2]AGUT T,LEóN M,REBOLLO M,et al.Early identification of brain injury in infants with hypoxic ischemic encephalopathy at high risk for severe impairments:accuracy of MRI performed in the first days of life[J].BMCPediatr,2014,14:177.
[3]PIERRAT V,HAOUARI N,LISKA A,et al.Prevalence,causes,and outcome at 2 years of age of newborn encephalopathy:population based study[J].Arch Dis Child Fetal Neonatal Ed,2005,90(3):F257-F261.
[4]FILIPPI L,FIORINI P,DANIOTTI M,et al.Safety and efficacy of topiramate in neonates with hypoxic ischemic encephalopathy treated with hypothermia(NeoNATI)[J].BMC Pediatr,2012,12:144.
[5]BERGER R P.The use of serum biomarkers to predict outcome after traumatic brain injury in adults and children[J].J Head Trauma Rehabil,2006,21(4):315-333.
[6]GUZEL A,ER U,TATLI M,et al.Serum neuronspecific enolase as a predictor of short-term outcome and its correlation with Glasgow Coma Scale in traumatic brain injury[J].Neurosurg Rev,2008,31(4):439-444.
[7]CHABOK S Y,MOGHADAM A D,SANEEI Z,et al.Neuron-specific enolase and S100BB as outcome predictors in severe diffuse axonal injury[J].J Trauma Acute Care Surg,2012,72(6):1654-1657.
[8]CELTIK C,ACUNAS B,ONER N,et al.Neuron-specific enolase as a marker of the severity and outcome of hypoxic ischemic encephalopathy[J].Brain Dev,2004,26(6):398-402.
[9]National Committee for Clinical Laboratory Standards.Method comparison and bias estimation using patient samples[S].EP9-A2,NCCLS,2002.
[10]TOLAN N V,VIDAL-FOLCH N,ALGECIRAS-SCHIMNICH A,et al.Individualized correction of neuronspecific enolase(NSE)measurement in hemolyzed serum samples[J].Clin Chim Acta,2013,424:216-221.
[11]GULCZYNSKA E,GADZINOWSK I J.Therapeut ic hypothermia for neonatal hypoxic-ischemic encephalopathy[J].Ginekol Pol,2012,83(3):214-218.
[12]HORN A R,S WINGLER G H,MYER L,et al.Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours[J].BMC Pediatr,2013,13:52.2018-04-19