摘要
目的探讨糖原磷酸化酶同功酶脑型(glycogen phosphorylase isoenzyme BB,GPBB)在新生儿窒息合并心肌损伤中的变化及与各种围生因素的相关性。方法随机选择64例窒息患儿为研究对象(轻度窒息39例,重度窒息25例;心肌损伤30例,非心肌损伤34例),以25例正常新生儿为对照组。采用酶联免疫吸附法(ELISA)测定血浆GPBB水平,同时检测心肌酶、肌钙蛋白I、心电图、X线胸片等。结果心肌损伤患儿血浆GPBB(13.84,7.57ng/ml)明显高于非心肌损伤组(4.97,3.24ng/ml)和对照组(4.95,1.99ng/ml)(P<0.01)。GPBB、cTnI、CK-MB诊断心肌损伤的敏感性分别为90%、66.7%、83.3%,GPBB的敏感性优于cTnI(χ2=4.812,P<0.05),与CK-MB比较差异无统计学意义(χ2=0.577,P>0.05);GPBB、cTnI、CK-MB诊断心肌损伤的特异性分别为88.2%、91.2%、67.6%,GPBB的特异性优于CK-MB(χ2=4.191,P<0.05),与cTnI比较差异无统计学意义(χ2=0.159,P>0.05)。重度窒息组血浆GPBB水平(14.67,6.09ng/ml)与轻度窒息组(5.61,3.56ng/ml)和对照组比较均显著升高(P<0.01);轻度窒息组GPBB水平与对照组比较略升高,但差异无统计学意义(P>0.05)。血浆GPBB水平与羊水污染程度呈正相关(r=0.500,P<0.001);与Apgar评分呈负相关(r=-0.520,P<0.001)。结论GPBB可作为窒息新生儿早期诊断心肌缺血损伤的理想标志物,对窒息儿早期测定GPBB有助于判断新生儿有无心肌损伤及损害程度。
Objective To study the change of glycogen phosphorylase isoenzyme BB （GPBB） in neonates with asphyxia complicated with myocardial injury and its correlation with various perinatal factors.Methods Sixty-four neonates with asphyxia （including 39 mild asphyxia and 25 severe asphyxiated neonates,30 neonates with and 34 without myocardial injures） were enrolled and 25 healthy neonates were studied as control.The plasma levels of GPBB were measured by enzyme-linked immunosorbent assay （ELISA）.Myocardial enzymes,cardiac troponin I,electrocardiogram,chest X-ray were performed simultaneously.Results The plasma GPBB levels were significantly higher in neonates with myocardial injury （13.84,7.57 ng / ml） than those without myocardial injury （4.97,3.24 ng / ml） and control group （4.95,1.99 ng / ml） （ P 〈0.01）.The sensitivities of GPBB,cTnI and CK-MB in diagnosing myocardial injury were 90%,66.7% and 83.3%,respectively.The sensitivity of GPBB was significantly higher than that of cTnI （χ^2 = 4.812,P〈 0.05）,with no statistical difference between GPBB and CK-MB （χ^2 = 0.577,P〉 0.05）.The specificities of GPBB,cTnI and CK-MB in diagnosing myocardial injury were 88.2%,91.2% and 67.6%,respectively.The specificity of GPBB was significantly higher than that of CK-MB （χ^2 = 4.191,P〈 0.05）,with no statistical difference between GPBB and cTnI （χ^2 = 0.159,P〉 0.05）.Plasma GPBB levels were significantly higher in neonates with severe asphyxia （14.67,6.09 ng / ml） than those with mild asphyxia （5.61,3.56 ng / ml） and control group （P〈 0.01）.GPBB levels were higher in mildly asphyxiated neonates than those in control neonates,but with no statistical significance （ P〉 0.05） .Spearman rank correlation analysis showed that plasma GPBB levels positively correlated with the cloudiness of the amniotic fluid （r = 0.500,P〈0.001） and negatively correlated with Apgar score （r = -0.520,P〈0.001）.Conclusions This study indicated that GPBB can be used as an ideal biomarker of myocardial ischemia injury in neonates with asphyxia.The determination of GPBB in early neonatal period is useful in detecting and assessing the severity of myocardial injury.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2010年第3期226-230,共5页
Journal of Clinical Pediatrics
基金
兰州大学医学科研基金项目(No.Lzuyx200718)
