血浆S100B蛋白和髓鞘碱性蛋白与早产儿脑损伤的关系  

Relationship of plasma S100B and myelin basic protein level with brain damage in preterm infants

作　　者：陈珊[1] 李薇[2] 瞿柳红[3] 唐娟[1] 荣箫[1] 周伟[1] 

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心新生儿科,510120 [2]暨南大学附属东莞医院儿科 [3]广州市花都区妇幼保健院新生儿科

出　　处：《中华实用儿科临床杂志》2014年第12期902-906,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：广东省社会发展科技计划项目（2006836030006）;广州市科技支撑项目（200921-E121）;东莞市科技计划重点项目（20101051502501）

摘　　要：目的探讨髓鞘碱性蛋白（MBP）和S100B蛋白与早产儿脑室周围-脑室内出血（PVH—IVH）、脑室周围白质软化（PVL）的关系。方法选择2010年1月至2013年6月收入广州医科大学附属广州市妇女儿童医疗中心、广州市花都区妇幼保健院、暨南大学附属东莞医院NICU的385例胎龄〈34周早产儿，于出生后24h、3d、7d、14d时测定血浆S100B、MBP水平；出生后2—3d、满1周、2周、3周、4周行头颅B超检查，出院前或纠正胎龄满40周时行颅脑磁共振（MRI）检查。根据剔除标准剔除73例，入选312例，按B超或MRI检查结果有无脑损伤及脑损伤性质分为脑无损伤组、PVL组、PVH—IVH组。比较各组之间血浆S100B、MBP水平的差异，分析脑无损伤组S100B、MBP水平与胎龄的相关性。结果头颅B超和／或MRI检查显示：脑未受损伤204例（纳入脑无损伤组）；发生PVH—IYH69例（纳入PVH—IVH组）；发生PVL27例，PVL并PVH-IVH12例（均纳入PVL组）。血浆S100B水平：出生24h内及第3天时，PVH—IVH组血浆S100B水平明显高于脑无损伤组，PVL组血浆S100B水平明显高于脑无损伤组及PVH—IVH组（P均〈0．05）；第7天及第14天时，PVH—IVH组与脑无损伤组比较差异无统计学意义（P均〉0．05），PVL组血浆S100B水平仍然明显高于脑无损伤组及PVH—IVH组（P〈0．05）。血浆MBP水平：出生后24h内，第3天、第7天及第14天时PVH—IVH组血浆MBP水平与脑无损伤组比较差异无统计学意义（P〉0．05），而以上各个时间点PVL组血浆S100B水平明显高于脑无损伤组及PVH—IVH组（P均〈0．05）。胎龄与S100B、MBP的相关性分析：脑无损伤组血浆S100B水平与胎龄呈负相关（r=-0．483，P=0．006），血浆MBP水平与胎龄无相关性（r=-0．295，P=0．105）。结论存在脑损伤的早产儿在出生后24h内血浆S100B和MBP蛋白水平即可明显升高，而发生PVL的早产儿血浆S100B及MBP蛋白水平较Objective To study the relationships of plasma myelin basic protein （MBP） and S100B level with periventrieular hemorrhage-intraventricular hemorrhage （ PVH-IVH ） and periventricular leucumalacia （PVL） in preterm infants. Methods There were 385 cases of preterm infants whose gestational age was less than 34 weeks and were admitted in NICUs of Guangzhou Women and Children＇s Medical Center of Guangzhou Medical University, Guangzhou Huadu District Maternal and Child Health Hospital and Dongguan Hospital Affiliated to Jinan University from Jan. 2010 to Jun. 2013, enrolled in the study. The plasma levels of S100B and MBP protein were detected within 24 hours and on the 3rd ,7th, 14th day after birth. Cranial ultrasound （US） was preformed 2 -3 d, 1 week,2 weeks,3 weeks and 4 weeks after birth. They also received Cranial MRI examination before discharge or when the correct gestational age reached 40 weeks. According to the exclusion standard 73 cases were excluded. The included 312 eases were divided into 3 groups （no brain damage group,PVH-IVH group and PVL group） according to the result of cranial US and MRI. The differences of the plasma levels of S100B and MBP protein among each groups were compared, and the relationship of the plasma levels of S100B and MBP protein in no brain damage group with gestational age were analyzed. Results The results of cranial ultrasound and/or MRI showed ：204 cases had no brain damage （put in no brain damage group） , 69 cases had PVH-IVH （put in PVH-IVH group） ,and 27 cases had PVL, 12 cases had PVL and PVH-IVH （both put in PVL group）. The plasma level of S100B：within 24h and 3 d after birth, the serum levels of S100B in PVH-IVH group were significantly higher than those in no brain damage group （ P 〈 0.05 ） ; and the plasma levels of S100B in PVL group were significantly higher than those in no brain damage group and PVH-IVH group （ all P 〈 0.05 ）. On 7 d and 14 d after birth, there were no significant differences between PVH-IVH group

关 键 词：脑室周围-脑室内出血 脑室周围白质软化 婴儿 早产 S100B蛋白 髓鞘碱性蛋白 

分 类 号：R743[医药卫生—神经病学与精神病学]