血清NSE及aEEG动态变化早期预测窒息新生儿脑损伤的意义

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摘要目的: 探讨血清神经元特异性烯醇化酶(neuronspecific enolase，NSE)及振幅整合脑电图(amplitudeintegrated electroencephalography，aEEG)动态变化早期预测窒息新生儿脑损伤的临床意义。方法: 选取我院新生儿重症监护室住院治疗的66例足月窒息新生儿为窒息组，按窒息程度分为轻度窒息组46例和重度窒息组20例；选择同期无窒息足月儿为对照组（30例）。监测3组患儿生后24 h、3 d、7 d血清NSE及生后6 h、3 d、7 d 时aEEG的变化。所有窒息组患儿依据脑损伤MRI结果分为MRI阳性组、MRI阴性组，运用ROC曲线评估血清NSE及aEEG早期预测窒息新生儿脑损伤的临床意义。结果： ① 3个时间点重度窒息组血清NSE水平明显高于轻度窒息组和对照组。② 生后6 h、3 d、7 d，aEEG背景活动、睡眠觉醒周期（SWC）、痫性活动（SA）与窒息程度均存在相关性，生后6 h相关性r分别为0.678、0.621、0.437，生后3 d相关性r分别为0.739、0.863、0.746，生7 d相关性r分别为0.824、0.869、0.847，P均<0.05。③重度窒息组颅脑MRI阳性率明显高于轻度窒息组（χ2=4.521，P<0.05）。④ ROC曲线分析显示，生后24 h血清NSE浓度预测颅脑MRI阳性率的灵敏度和特异度最高，敏感度为0.875，特异度为0.885，当血清NSE水平达48.7 μg/L，其诊断价值最大。⑤ 由背景活动正常、SWC成熟度及SA运用ROC曲线预测颅脑MRI阳性率，生后6 h、3 d时aEEG的变化对早期窒息脑损伤的诊断价值较低，生后第7天aEEG的变化对窒息脑损伤无诊断价值。结论：血清NSE及aEEG动态变化对窒息新生儿脑损伤有监测和预警作用，对早期预测脑损伤有临床应用价值。

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	刘小晓
	张晓英

关键词 ：新生儿窒息, 神经元特异性烯醇化酶, 振幅整合脑电图, 磁共振, 脑损伤

Abstract：Objective: To explore the clinical significance of early prediction of brain injury in asphyxiated newborns by dynamic changes of serum neuronspecific enolase and amplitude-integrated electroencephalography(aEEG). Methods: Sixtysix fullterm neonates with asphyxia who were hospitalized in NICU, were selected as asphyxia group, and divided into mild asphyxia group (46 cases) and severe asphyxia group (20 cases) according to the degree of asphyxia. Fullterm neonates without asphyxia in the same period were selected as control group (30 cases). The changes of NSE and aEEG were monitored dynamically at three different time points (24 h, 3 d, 7 d after birth and 6 h, 3 d, 7 d after birth). All the children in the asphyxia group were divided into MRI + group and MRI - group according to the results of magnetic resonance imaging. The clinical significance of serum NSE and aEEG in early prediction of brain injury in asphyxiated neonates was evaluated by ROC curve. Results: ① The serum NSE level in severe was significantly higher than that in the control group and in mild asphyxia group at three different time points. ② At 6 h, 3 d and 7 d after birth, aEEG background activity, SWC and SA were correlated with the degree of asphyxia. The correlation coefficient(r) of aEEG background activity, SWC and SA with the degree of asplyxia at 6 h after birth was 0.678, 0.621 and 0.437. The r of aEEG background activity, SWC and SA with the degree of asplyxia at 3 d after birth was 0.739, 0.863 and 0.746, respectively. The r of aEEG background activity, SWC and SA at 7 d after birth was 0.824, 0.869 and 0.847. ③ The degree of asphyxia was associated with the positive rate of MRI（χ2=4.521，P<0.05）. ④ The ROC curve was used to evaluate the diagnostic value of changes in serum NSE concentration at three different time points (24 h, 3 d, 7 d). The sensitivity and specificity were the highest in the group of MRI + at 24 h after birth. The sensitivity and specificity were 0.875 and 0.885. When the serum NSE level reached 48.7 μg/L, the diagnostic value was the highest. ⑤ Using ROC curve to predict the positive rate of craniocerebral MRI from normal background activity, maturity of SWC and SA, the changes of aEEG at 6 h and 3 d after birth were of low diagnostic value for early asphyxiated brain injury, and the changes of aEEG at 7 d after birth was of no diagnostic value for asphyxiated brain injury. Conclusion: The dynamic changes of serum NSE and aEEG may be used to monitor and provide early warning of asphyxiated brain injury, and have clinical application value for early prediction of brain injury.

收稿日期: 2019-10-08

通讯作者: 张晓英(通讯作者)，主任医师，E-mail: doczxy@sina.com

作者简介: 刘小晓（1989—），女，住院医师，硕士，主要从事新生儿疾病研究

引用本文:

刘小晓，张晓英. 血清NSE及aEEG动态变化早期预测窒息新生儿脑损伤的意义[J]. 江苏大学学报:医学版, 2020, 30(02): 154-159,164. LIU Xiao-xiao， ZHANG Xiao-ying.

Significance of serum NSE and aEEG dynamic changes in early prediction of neonatal brain injury in asphyxia

. Journal of Jiangsu University(Medicine Edition), 2020, 30(02): 154-159,164.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2020/V30/I02/154

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