摘要
目的探讨不同胎龄（GA）新生儿早期血清神经系统相关性蛋白的变化，评价其在新生儿啮损伤中的临床意义。方法120例不同GA的新生儿，其中无脑损伤者84例，脑损伤者36例。无脑损伤新生儿按GA分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组，其GA分别为～28周，～32周，～35周，37～41”周。脑损伤者分为足月儿缺氧缺血性脑病（HIE）组，早产儿脑损伤（PBL）组。根据GA分别选取无啮损伤的足月儿28例（健康足月儿组）和早产儿20例（NPBL组）作为脑损伤患儿的对照。所有观察对象于生后2～3d以酶联免疫吸附试验测定血清神经特异性烯醇化酶（NSE）、S100蛋白（S100）、髓鞘碱性蛋白（MBP），其中27例于出生7d后再次测定。结果（1）Ⅰ、Ⅱ、Ⅲ、Ⅳ组的血清NSE、MBP、S100水平差异无显著性（P〉0．05）。出生3d内及7d后血清MBP水平差异无显著性（P〉0．05），而NSE、S100不同日龄差异均有显著性（P〈0．05）。MBP、NSE与GA无明显相关性，S100与GA轻度负相关（r=-0．270，P〈0．05）。（2）HIE组与健康足月儿组的血清NSE水平分别为（97．16±63．00）μg／L、（35．60±25．08）μg／L，差异有非常显著性（P〈0．01），而MBP、S100两组比较．差异无显著性（P〉0．05）；PBL组与NPBL组比较，血清NSE、MBP、S100差异均无显著性。结论（1）S100血清浓度受新生儿GA的影响，而NSE、MBP与GA无关。NSE、S100血清浓度随生后日龄而变化，MBP则相对稳定。（2）NSE是早期反映HIE的指标，而MBP、S100对HIE的早期诊断价值有限。血清NSE、MBP、S100的变化对早产儿脑损伤的早期诊断价值有限。
Objective To investigate the changes of the serum proteins related to nervous system in neonates with different gestational age （CA） in the early stage. In this study we also attempt to evaluate the clinical value of these indexes in the neonates with brain lesion. Methods One hundred-twenty newborns with different GA including 84 cases without brain lesion and 36 cases with brain lesion were selected. The 84 newborns without brain lesion were categorized into 4 groups （Ⅰ、Ⅱ、Ⅲ、and Ⅳ ） according to GA which were ～28 w, ～32 w,～35 wand 37～41^＋6 w respectively. The newborns with brain injury were categorized into hypoxie-ischemic encephalopathy （HIE） group and the preterrn brain lesion group. Twenty-eight term infants and 20 preterm infants without brain lesion were selected according to GA respectively as the control groups. Serum neuron-specific enolase （NSE）, S100 protein （S100） and myelin basic protein （MBP） were measured at the age of 2 ～ 3 days after birth by enzyme linked immunosorbent assay in all observing objects. Serum NSE,S100 and MBP were measured again in 27 newborns at age 7 to 28 days without brain lesion. Results （1） The levels of serum MBP, NSE and S100 among Ⅰ, Ⅱ, Ⅲ and Ⅳ groups have not been shown significantly different （P 〉0.05）. Serum NSE and S100 increased at the age of 2～3 days compared with them at the age 7 to 28 days in the newborns without brain lesion （P = 0. 018,0. 016 respectively）. However, serum MBP among different stages showed no significant difference （ P 〉 0.05 ）. There was minor negative relation between serum S100 and GA （ r = - 0. 270, P = 0. 013 ）. There was no significant relationships among GA, serum MBP and NSE. （2） Serum NSE of the HIE and control group was （97.16± 63.00） μg/L, （35.60± 25.08）μg/L respectively, NSE of HIE group was higher compared with control group （P = 0. 000）, but no significant differences were found between HIE and the control group in serum MBP and S100 （P 〉 0.05）. There were no significant differences between preterm brain lesion （PBL） and no preterm brain lesion （NPBL） in serum NSE, MBP and S100. Conclusion （ 1 ） Serum S100 is related to neonatal maturity but serum MBP and NSE are not associated with neonatal maturity. Serum NSE and S100 change with day-age after birth, but serum MBP is relatively stable in the neonatal stage. （2） Serum NSE is an early predicting index in the term infants with HIE, but the serum MBP and S100 are of limited value in the early diagnose of HIE. Serum NSE.MBP and 8100 showed limited value in brain injury diagnosis among the preterm infants.
出处
《中国小儿急救医学》
CAS
2008年第1期17-20,共4页
Chinese Pediatric Emergency Medicine
基金
深圳市卫生局重点项目（200647）
关键词
新生儿
胎龄
缺氧缺血性脑病
脑室内出血
脑室周围白质软化
特异性神经烯醇化酶
S100蛋白
髓鞘碱性蛋白
Infant, newborn
Gestational age
Hypoxic-ischemic encephalopathy
Intraventricular hemorrhage
Periventricular leukomalacia
Neuron-specific enolase
S100 protein
Myelin basic protein
