血清GFAP结合颅脑MRI检查在新生儿缺氧缺血性脑病中的临床价值  

The clinical research of serum glial fibrillary acidic protein combined with craniocerebral MRI in neonatal hypoxic-ischemic encephalopathy

作　　者：刘春丽[1] 梅花[1] 张亚昱[1] 胡亚楠[1] 呼斯乐 Liu Chunli;Mei Hua;Zhang Yayu;Hu Yanan;Husile(Department of Neonatology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院新生儿科

出　　处：《中国医师杂志》2019年第11期1621-1625,共5页Journal of Chinese Physician

基　　金：内蒙古自治区自然科学基金项目[2017MS(LH)0831];内蒙古医科大学青年创新基金(YKD2016QNCX023)~~

摘　　要：目的寻找血清胶质纤维酸性蛋白(GFAP)水平与新生儿缺氧缺血性脑病(HIE)的关系,求证GFAP结合颅脑磁共振成像(MRI)检查是否能更准确地评估HIE的预后。方法选择2017年1月至12月于本院新生儿科住院治疗的HIE患儿,以及同期住院治疗的无脑损伤的足月新生儿为研究对象。于HIE患儿生后第1、3、7天及无脑损伤的足月新生儿生后第3天采取血清标本进行GFAP检测,并对所有HIE患儿行颅脑MRI检查同时进行跟踪随访,比较患儿血清GFAP水平,同时评估GFAP水平同颅脑MRI检查严重程度是否存在相关性。结果⑴HIE组患儿出生后第3天血清GFAP水平[(5. 54±1. 30) ng/ml]明显高于对照组[(3. 38±0. 31) ng/ml](P <0. 01);⑵不同程度HIE患儿血清GFAP水平比较:第1、3、7天血清GFAP水平重度组分别为(5. 56±1. 89) ng/ml,(6. 42±1. 63) ng/ml,(7. 22±1. 30) ng/ml;中度组分别为(5. 07±0. 62) ng/ml,(6. 73±0. 77) ng/ml,(6. 25±0. 81) ng/ml;轻度组分别为(4. 20±0. 13) ng/ml,(5. 34±0. 33) ng/ml,(4. 52±0. 33) ng/ml。比较发现第1、3、7天血清GFAP水平重度组高于中度组和轻度组,中度组高于轻度组(各组比较均P <0. 01);⑶后遗症组和无后遗症组HIE患儿血清GFAP水平比较:后遗症组第1、3天血清GFAP水平[分别为(5. 22±1. 52) ng/ml,(6. 48±1. 17) ng/ml]与无后遗症组[分别为(4. 47±0. 50) ng/ml,(5. 75±0. 88) ng/ml]比较,差异无统计学意义(P> 0. 05);后遗症组第7天血清GFAP水平[(6. 93±1. 29) ng/ml]与无后遗症组[(4. 91±0. 77) ng/ml]比较,差异有统计学意义(P <0. 01);⑷MRI异常组及MRI正常组HIE患儿血清GFAP水平比较:颅脑MRI异常组第1、3、7天血清GFAP水平分别为(5. 25±1. 28) ng/ml,(6. 66±1. 10) ng/ml,(6. 64±1. 08) ng/ml,明显高于MRI正常组[分别为(4. 26±0. 25) ng/ml,(5. 41±0. 40) ng/ml,(4. 62±0. 48) ng/ml,P均<0. 05]。颅脑MRI轻度异常组第1、3、7天血清GFAP水平分别为(4. 92±0. 90) ng/ml,(6. 42±0. 47) ng/ml,(5. 95±0. 58) ng/ml;颅脑MRI�Objective To explore the relationship between serum glial fibrillary acidic protein( GFAP) level and neonatal hypoxic-ischemic encephalopathy( HIE),and to verify whether GFAP combined with craniocerebral magnetic resonance imaging( MRI) can more accurately evaluate the prognosis of HIE. Methods We selected HIE children who hospitalized in the department of neonatology,the affiliated hospital of Inner Mongolia Medical University from January 2017 to December 2017,and full-term newborns without brain injury who were hospitalized in the same period. Serum samples were taken for GFAP detection on the 1 st,3 rd,7 th day after birth of HIE and the 3 rd day after birth of full-term newborns without brain injury. All the subjects completed craniocerebral MRI examination and followed up. At the same time,the correlation between GFAP level and the severity of brain MRI was evaluated. Results ⑴ The level of serum GFAP in HIE group on the 3 rd day after birth [( 5. 54 ± 1. 30) ng/ml]was significantly higher than that in control group [( 3. 38 ± 0. 31) ng/ml]( P < 0. 01) . ⑵ Comparison of serum GFAP levels in HIE children with different degrees: the serum levels of GFAP in the severe group on the 1 st,3 rd and 7 th day were as follows:( 5. 56 ± 1. 89) ng/ml,( 6. 42 ± 1. 63) ng/ml,( 7. 22 ± 1. 30) ng/ml;the serum levels of GFAP in moderate group on the 1 st,3 rd and 7 th day were as follows:( 5. 07 ± 0. 62) ng/ml,( 6. 73 ±0. 772) ng/ml,( 6. 25 ± 0. 812) ng/ml;the serum levels of GFAP in mild group on the 1 st,3 rd and 7 th day were as follows:( 4. 20 ± 0. 13) ng/ml,( 5. 34 ± 0. 33) ng/ml,( 4. 52 ± 0. 33) ng/ml;the serum GFAP levels in severe group were higher than those in moderate group and mild group on the 1 st,3 rd and 7 th day,and those in moderate group were higher than those in mild group( P < 0. 01) . ⑶ Comparison of serum GFAP levels between sequelae group and non-sequelae group: there was no significant difference between sequelae group [( 5. 22 ± 1. 52) ng/ml,( 6. 48 ± 1. 17) ng/ml] and non-sequel

关 键 词：神经胶质原纤维酸性蛋白质 磁共振成像 缺氧缺血 脑 婴儿 新生 疾病 

分 类 号：R72[医药卫生—儿科]