摘要
目的探讨尿乳酸/肌酐(Lac/Cr)比值和尿S100B蛋白对新生儿窒息和缺氧缺血性脑病(HIE)预后判断的价值。方法检测78例足月窒息新生儿生后第1、2、3天尿Lac/Cr比值、尿S100B蛋白水平,对其中HIE患儿生后3、7、14、28d分别进行新生儿神经行为评分(NBNA评分),在生后6个月对HIE患儿进行智能发育筛查测验(DST),同期25名足月正常新生儿为对照组。结果窒息组与对照组1、5minApgar评分、第1天尿Lac/Cr比较差异均有统计学意义(P<0·001)。窒息组第1天尿Lac/Cr与1、5minApgar评分呈负相关,差异有统计学意义(P<0·01)。HIE组第1天尿Lac/Cr比值、所有监测时间段尿S100B蛋白与生后3、7、14dNBNA评分呈负相关。生后6个月36例HIE患儿接受了DST随访(随访率46·15%),20例中重度HIE中DQ70～84分7例,第1天尿Lac/Cr介于4·69～6·24,3d内尿S100B蛋白介于3·49～5·87μg/L;DQ<70分13例,第1天尿Lac/Cr比值>6·22,3d内尿S100B蛋白介于5·35～8·86μg/L。结论尿Lac/Cr比值>4·69而尿S100B>3·49μg/L时,HIE可能预后不良。监测出生后第1天尿Lac/Cr比值和3d内尿S100B蛋白对预测HIE的预后具有较高的应用价值,值得进一步研究。
Objective To study the value of measuring urinary S100B protein and Lactate/ Creatinine （Lac/Cr） ratio to predict the prognosis of neonatal asphyxia and hypoxic-ischemic encephalopathy （HIE） in full term infants. Methods Seventy-eight full term asphyxiated infants and 25 healthy full term infants were studied as experimental and control groups respectively. The levels of urinary S100B protein and urinary Lac/Cr ratio of all infants were measured on the first, second, and third day after birth. Their clinical manifestations were monitored closely is the first 7 days after birth to assess the degree of HIE. The infants diagnosed with HIE were evaluated with 20-item NBNA （Neonatal Behavioral Neurological Assessment） at day 3, 7, 14 and 28 after birth, and they were evaluated with the Developmental Screening Test （DST） at 6 month of age. Results There were significant differences in level of urinary Lac/Cr ratio in first 24 hours after birth and Apgar scores at 1 minute and 5 minutes between infants in experimental and control groups （ P 〈 0. 001 ）. The levels of urinary Lac/Cr ratio in first 24 hours and the Apgar score at 1 minute and 5 minutes showed negative correlations between infants in experimental group and control group （ P 〈 0.01 ）. The urinary Lac/Cr ratio and the level of S100B protein within 24 hours after birth showed negative correlations with the score of NBNA on the 3^rd, 7^th and 14^th day after birth. Thirty-six infants （46. 15% ） suffered from HIE were followed up and evaluated by the developmental screening test （DST） at 6 month of age. Twenty infants diagnosed with moderate or severe HIE. Seven of them DQ scored was 70 to 84, their first day urinary Lac/Cr ratio was 4. 69 to 6.24 and level of S100B protein was 3.49 to 5.87 μg/L for the first 3 days after birth. Thirteen infants had even lower DQ score, 〈 70. Their first day uninary Lac/Cr ration was greater than 6.22, S100B protein level within the first 3 days was 5.35 to 8.86 μg/L Conclusion Urinary Lac/Cr ratio exceeded 4.69 and level of S100B protein exceeded 3.49 μg/L predict poor prognosis of HIE. The level of urinary S100B within first 3 days and urinary Lac/Cr ratio in first 24 hours can be very valuable indicators for prognosis of HIE in its early stage in full term infants.
出处
《中国新生儿科杂志》
CAS
2008年第3期141-144,共4页
Chinese Journal of Neonatology
关键词
蛋白
乳酸
缺氧缺血
脑
Egg white
Lactic acid
Hypoxia-ischemia, brain
