新生儿缺氧缺血性脑病血清IL-18变化的临床意义  

Value of serum IL-18 in neonates with hypoxic-ischemic encephalopathy

作　　者：余增渊[1] 李天慧[1] 朱阿瑾[1] 方霞[1] 

机构地区：[1]河南南阳市第一人民医院儿科,南阳473010

出　　处：《中国实用神经疾病杂志》2010年第9期13-16,共4页Chinese Journal of Practical Nervous Diseases

摘　　要：目的研究新生儿缺氧缺血性脑病发病过程中血清(白介素-18)IL-18水平变化,探讨IL-18在判断新生儿缺氧缺血性脑损伤的程度和预后的临床价值。方法采用酶联免疫吸附试验检测42例足月HIE患儿(轻度24例,中度10例,重度8例)及20例正常足月新生儿生后第1天、第7天血清IL-18水平,并于生后第7天做新生儿行为神经测定(NBNA),比较各组间各指标的差异;建立受试者工作曲线(ROC曲线),确定血清IL-18 ROC曲线下的面积(AUC),同时分析不同截断值的敏感度、特异度、阳性和阴性预测值。结果 (1)轻度HIE组与中、重度HIE组患儿的IL-18水平较对照组显著升高,P<0.01;(2)不同程度HIE组IL-18水平随脑损伤程度加重而增加,各组间差异显著,P<0.01;(3)各组HIE患儿恢复期(生后7d)血清IL-18水平较急性期(生后1 d)均有明显下降,各组间有显著性差异,P<0.01;(4)IL-18的AUC为89.8%,当IL-18>600.36 ng/L时,其敏感度、特异度、阳性及阴性预测值分别为89.2%、86.8%、87.1%、89.2%。结论动态监测IL-18水平变化可以作为HIE患儿早期预后判断的辅助性指标。Objective To study the level of serum IL-18 in neonatal with hypoxic -ischemic encephalopathy（HIE） and to explore clinical value of serum IL-18 for brain damage on neonatal with hypoxic-ischemic in judgment and prognosis. Methods The level of serum IL-18 in the 1st and 7th day after birth of the 42 cases term-infant with HIE （24 cases were mild HIE, 10 cases were moderate HIE and 8 cases were severe HIE ） were measured by Enzyme Linked Immunosorbent Assay（ELISA） ,and compared to 20 cases of normal newborns. The neonatal behavioral neurological assessment done （NBNA was tested） in the 7th day after birth. The area under the receiver operating characteristic（ROC）and optimum sensitivity, specificity,predictive values were evaluated. Results （1）The levels of serum IL-18 in mild, moderate and severe HIE groups were both significantly higher than those in controls （P〈0.01） ;（2）With increasing the degree of brain injury, the level of serum IL-18 increased, the intergroup difference was significant （P〈0. 01） ;（3）Compared to acute period（the 1st day after birth）,the level of serum IL-18 was clearly decreased in recovery stage（the 7th day after birth） in all HIE groups, the differences were significant（ P〈0. 01）;（4） The area under ROC curve was 83.2% for IL-18, when the content of IL-18 was more than 600. 36 ng/L. The sensitivity, specificity, and positive and negative predictive value were 89.2 %, 86.8 %, 87.10%, and 89.2 %. Conclusion Dynamic monitoring the level of serum IL-18 can act as the supporting indicators for early prognosis for HIE newborns.

关 键 词：缺氧缺血性脑病 白介素-18 神经行为评分 脑损伤 

分 类 号：R722.1[医药卫生—儿科]