神经元特异性烯醇化酶在危重症患儿脑功能监测中价值及单唾液酸四己糖神经节苷酯早期治疗危重症患儿脑损伤效果  

The Value of Neuron-Specific Enolase in Brain Function Monitoring and the Curative Effect of Monosialotetrahexosyl Gangliosides in the Early Treatment of Cerebral Injury of Critically Ill Children

作　　者：邢莉莉[1] 张敏[1] 魏红霞[1] 朱月钮[1] 朱晓东[1] XING Li-li;ZHANG Min;WEI Hong-xia;ZHU Yue-niu;ZHU Xiao-dong(Department of Pediatric Critical Care,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院小儿重症医学科,上海200092

出　　处：《临床误诊误治》2018年第8期90-94,共5页Clinical Misdiagnosis & Mistherapy

基　　金：上海市科委项目(14DZ1942002)

摘　　要：目的探讨神经元特异性烯醇化酶(NSE)在危重症患儿脑功能监测中价值及单唾液酸四己糖神经节苷酯(GM1)早期治疗危重症患儿脑损伤效果。方法选取2014年9月—2016年12月上海交通大学医学院附属新华医院小儿重症医学科收治的危重症患儿60例,根据小儿危重症评分(PCIS)分为危重组(PCIS≤80分)和非危重组(PCIS>80分)两组各30例,观察比较两组入院后24、72 h和7 d血清NSE蛋白含量。后将前述脑功能监测研究中危重组30例作为常规治疗组,选取2016年12月—2017年7月上海交通大学医学院附属新华医院小儿重症医学科收治的PCIS≤80分的危重症患儿16例作为GM1治疗组。GM1治疗组在常规治疗基础上加用GM1,常规治疗组予常规治疗。检测比较两组入院时及治疗2周后血清NSE蛋白含量,并分析GM1治疗对危重症患儿重症监护病房(ICU)住院天数和病死率的影响。结果危重组与非危重组入院后24、72 h及7 d血清NSE蛋白含量均高于正常参考值。危重组入院后24、72 h及7 d血清NSE蛋白含量均较非危重组明显升高,差异有统计学意义(P<0.05)。治疗2周后血清NSE蛋白含量GM1治疗组较入院时降低,常规治疗组较入院时升高,GM1治疗组明显低于常规治疗组,差异均有统计学意义(P<0.05)。GM1治疗组和常规治疗组ICU住院天数和病死率比较差异无统计学意义(P>0.05)。结论 NSE有助于早期评估危重症患儿脑损伤程度,在危重症患儿脑功能监测中有重要价值。危重症患儿早期应用GM1对减轻脑损伤、促进脑功能恢复具有一定作用,但对减少ICU住院天数及降低病死率意义不大。Objective To discuss the value of neuron-specific enolase(NSE)in cerebral function monitoring,and to survey the curative effect of monosialotetrahexosyl ganglioside(GM1)in early treatment of cerebral injury of critically ill children.Methods A total of 60 critically ill children who were admitted to PICU,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from September 2014 to December 2016 were enrolled in this study.They were categoried into two groups,critical group(n=30,≤80 scores)and non-critical group(n=30,>80 scores),according to pediatric critical illness score(PCIS).NSE concentration in blood serum samples from these patients were examined at 3 time points(24 h,72 h and 7 d)respectively after admission.Based on the study of above-mentioned brain function monitoring,30 cases from critical group were enrolled as the control group.And 16 critically ill children with PCIS≤80 scores admitted to PICU of our hospital from December 2016 to July 2017 were enrolled as GM1 treatment group.GM1 was added to the treatment group on the base of conventional therapy,whereas the control group was treated with conventional therapy.NSE concentration in blood serum samples from two groups above were examined at admission and two weeks after GM1 treatment.The effect of GM1 on mortality rate and the length of hospital stay was also analyzed and compared in both groups.Results The concentrations of NSE in critical group and non-critical group were higher than normal reference value at 24 h,72 h and 7 d after admission.The concentration of NSE in blood serum was increased incrementally in patients of critical group than non-critical group at three time points(24 h,72 h and 7 d)respectively,which were significantly different(P<0.05).After 2 weeks of treatment,concentration of NSE in blood serum in GM1 treatment group was lower than that at the time of admission,showing significant differences(P<0.05),whereas the concentration of NSE in the control group was higher than that at the time of admission,

关 键 词：危重症 儿童 神经元特异性烯醇化酶 单唾液酸四己糖神经节苷酯 

分 类 号：R725[医药卫生—儿科]