血清前白蛋白和神经元特异性烯醇化酶检测在新生儿缺氧缺血性脑病诊断中的临床意义
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摘要
目的:探讨血清前白蛋白(PA)和神经元特异性烯醇化酶(NSE)水平对于诊断新生儿缺氧缺血性脑病(HIE)的临床价值。方法:选取HIE新生儿45例作为观察组,根据临床分度分为轻度21例,中度19例,重度5例;同期选取正常新生儿24名作为对照组。检测患儿血清中PA和NSE的水平,比较其在不同临床分度中的表达差异。结果:出生后第1、3天,各组PA水平差异均有统计学意义(P<0.01),且随着HIE分度增加,PA水平下降(P<0.05～P<0.01),3组HIE患儿的PA水平均低于对照组(P<0.01);出生后第10天,3组HIE患儿的PA水平均低于对照组(P<0.01),重度组与轻度组、重度组与中度组PA水平差异无统计学意义(P>0.05)。出生后1、3、10天,各组血清NSE水平间差异均有统计学意义(P<0.01);轻度组和对照组之间差异无统计学意义(P>0.05),中度组和重度组均高于对照组(P<0.01);且重度组高于中度组(P<0.01)。结论:新生儿HIE患儿的血清PA水平随着HIE分度增加而下降,而血清NSE水平随着HIE分度增加而增加。新生儿血清中PA、NSE水平可用于预测、诊断HIE的发生,判断病情的严重程度及预后。
Objective:To evaluate the clinical significance of the combined detection of serum prealbumin(PA) and neuron-specific enolase(NSE) in the diagnosis of neonatal hypoxic ischemic encephalopathy(HIE).Methods:A total of 45 neonates with HIE(including mild HIE 21 cases,moderate HIE 19 cases and severe HIE 5 cases) and 24 normal neonates were divided into the observation group and control group,respectively.The serum level of PA and NSE in observation group were detected,and the differences of which among three degrees HIE neonates were compared.Results:After 1 and 3 d of birth,the differences of the serum level of PA in neonates with HIE were statistically significant(P<0.01),with the increasing of HIE degree,the level of PA gradually decreased(P<0.05 to P<0.01),and the level of PA in three degrees HIE patients were lower than that in control group(P<0.01).After 10 d of birth,the level of PA in three degrees HIE patients were lower than that in control group(P<0.01),and the differences of the PA level between severe HIE patients and mild HIE,moderate HIE patients were not statistically significant(P>0.05).After 1,3 and 10 d of birth,the difference of the serum level of NSE in neonates with HIE was significant(P<0.01),the difference of the serum level of NSE between mild HIE patient and control group was not statistically significant(P>0.05),the serum level of NSE in mild and moderate HIE patients were higher than that in control group(P<0.01),and the serum level of NSE in severe HIE patients was higher than that in moderate group(P<0.01).Conclusions:With the increasing of HIE degree of neonates,the serum level of PA gradually decreases,and the serum level of NSE gradually increases.The serum level of PA and NSE can be used for predicting and diagnosing HIE,and judging the prognosis and severity of disease.
Objective:To evaluate the clinical significance of the combined detection of serum prealbumin(PA) and neuron-specific enolase(NSE) in the diagnosis of neonatal hypoxic ischemic encephalopathy(HIE).Methods:A total of 45 neonates with HIE(including mild HIE 21 cases,moderate HIE 19 cases and severe HIE 5 cases) and 24 normal neonates were divided into the observation group and control group,respectively.The serum level of PA and NSE in observation group were detected,and the differences of which among three degrees HIE neonates were compared.Results:After 1 and 3 d of birth,the differences of the serum level of PA in neonates with HIE were statistically significant(P<0.01),with the increasing of HIE degree,the level of PA gradually decreased(P<0.05 to P<0.01),and the level of PA in three degrees HIE patients were lower than that in control group(P<0.01).After 10 d of birth,the level of PA in three degrees HIE patients were lower than that in control group(P<0.01),and the differences of the PA level between severe HIE patients and mild HIE,moderate HIE patients were not statistically significant(P>0.05).After 1,3 and 10 d of birth,the difference of the serum level of NSE in neonates with HIE was significant(P<0.01),the difference of the serum level of NSE between mild HIE patient and control group was not statistically significant(P>0.05),the serum level of NSE in mild and moderate HIE patients were higher than that in control group(P<0.01),and the serum level of NSE in severe HIE patients was higher than that in moderate group(P<0.01).Conclusions:With the increasing of HIE degree of neonates,the serum level of PA gradually decreases,and the serum level of NSE gradually increases.The serum level of PA and NSE can be used for predicting and diagnosing HIE,and judging the prognosis and severity of disease.
引文
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[11] BLOOMFIELD FH,CROWTHER CA,HARDING JE,et al.The ProVIDe study:the impact of protein intravenous nutrition on development in extremely low birthweight babies[J].BMC Pediatrics,2015,15:100.
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[13] CORRIGAN ML,ESCURO AA,CELESTIN J,et al.Nutrition in the stroke patient[J].Nutr Clin Pract,2011,26(3):242.
[2] 刘丁香,彭好,王春燕,等.新生儿缺氧缺血脑病血神经特异性烯醇化酶浓度变化及临床意义[J].四川医学,2015,36(2):178.
[3] 杨琪炜,赵文穗.纳络酮对肺性脑病患者血清神经元特异性烯醇化酶的影响[J].实用临床医药杂志,2013,17(9):105.
[4] 王春艳,彭好,夏长明,等.脑损伤新生儿血清神经元特异性烯醇化酶动态变化及临床意义[J].现代医药卫生,2016,32(14):2138.
[5] 张秀明.新编临床生物化学实验诊断[M].郑州:河南医科大学出版社,1996:554.
[6] ALAM JM,BAIG JA,MAHMOOD SR,et al.Diagnostic utility of neuron specifie (NSE) in serum and pleural fluids from patients with lung cancer and tuberculosis [J].Pak J Biochem,2010,43(3):873.
[7] GOODMAN MD,MAKLEY AT,HUBER NL,et al.Hypobaric hypoxia exacerbates the neuroinflammatory response to traumatic brain injury?[J].J Surg Ret,2011,165(1):30.
[8] KAYA T,SIPAHI S,KARACAER C,et al. Evaluation of nutritional status with different methods in geriatric hemodialysis patients:impact of gender[J].Int Urol Nephrol,2014,46(12):2385.
[9] EI-MAZARY AA,NASIF KA,ABDEL-HAKEEM GL,et al.Adiponectin,leptin and insulin levels at birth and in early postnatal life in neonates with hypoxic ischemic encephalopathy[J].J Diabetes Metab Disord,2015,14(1):87.
[10] 庄根苗,唐玲,臧丽娇,等.新生儿缺氧缺血性脑病中血清前白蛋白水平与新生儿行为神经测定的相关性[J].山东大学学报(医学版),2016,54(12):37.
[11] BLOOMFIELD FH,CROWTHER CA,HARDING JE,et al.The ProVIDe study:the impact of protein intravenous nutrition on development in extremely low birthweight babies[J].BMC Pediatrics,2015,15:100.
[12] HUTCHINSON E,WILSON N.Acute stroke,dysphagia andnutritional support[J].Br J Community Nurs,2013,Suppl:S26.
[13] CORRIGAN ML,ESCURO AA,CELESTIN J,et al.Nutrition in the stroke patient[J].Nutr Clin Pract,2011,26(3):242.