新生儿缺氧缺血性脑病亚低温治疗后的肝损伤生物标志物的变化  

Changes of Biomarkers of Liver Injury in Neonates with Hypoxic-ischemic Encephalopathy After Mild Hypothermia Treatment

作　　者：张洁[1] 王芳会[1] 李媛[1] 张文君 司宇君 吴芳[1] 金刚[2] ZHANG Jie;WANG Fanghui;LI Yuan;ZHANG Wenjun;SI Yujun;WU Fang;JIN Gang(Department of Neonatology,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Nephrology,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]西安交通大学第一附属医院新生儿科,陕西西安710061 [2]陕西省人民医院肾内科,陕西西安710068

出　　处：《标记免疫分析与临床》2020年第6期920-925,共6页Labeled Immunoassays and Clinical Medicine

基　　金：陕西省社会发展科技攻关项目(编号:2016SF-123)。

摘　　要：目的为了考察新生儿缺氧缺血性脑病(HIE)亚低温治疗后的肝损伤生物标志物的变化。方法回顾性分析2011年9月1日至2019年9月30日期间我院收治并确诊的HIE新生儿的临床资料,收集从入院直至产后7天的所有新生儿(常温治疗117例,亚低温治疗241例)的每日血液检查结果。检测指标包括:丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、凝血酶原时间(PT)、部分凝血活酶时间(PTT)和C反应蛋白(CRP)。记录每种生物标志物第一周内每天的血浆峰值及异常情况。结果 ALT、AST和CRP的峰值和异常比例随着HIE严重程度的升高而增加(P<0.001)。随着HIE严重程度的升高,ALB的峰值和异常比例逐渐降低,而PT和PTT的峰值逐渐升高(P<0.001)。与常温治疗组相比,亚低温治疗组的ALT、AST、ALB和CRP达峰值时间均延长(P<0.05),而两组的PT和PTT达峰值时间差异无统计学意义(P>0.05)。与常温治疗组相比,亚低温治疗组的中度和重度HIE新生儿的ALT、AST和CRP峰值显著降低,而ALB显著增加,并且ALT、ALB和CRP的异常比例也具有相同的变化趋势(P<0.05)。两组的PT和PTT水平和异常比例差异无统计学意义(P>0.05)。结论亚低温治疗可有效降低HIE新生儿的ALT、ALB和CRP峰值和异常比例,并延长其达峰值时间,该三项指标可以反映亚低温对新生儿的肝脏保护效果。Objective To investigate the changes of liver injury biomarkers after mild hypothermia treatment of neonatal hypoxic-ischemic encephalopathy.Methods The clinical data of HIE neonates admitted and diagnosed in our hospital from September 1,2011 to September 30,2019 were retrospectively analyzed.The daily blood test results of all newborns(117 cases treated with normothermia and 241 cases treated with mild hypothermia)from admission to 7 days postpartum were collected.Test indicators were included as following:alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),prothrombin time(PT),partial thromboplastin time(PTT)and C reaction Protein(CRP).The peak plasma concentrations and abnormalities of each biomarker in the first week were recorded.Results The peak and abnormal ratios of ALT,AST and CRP increased with the severity of HIE(P<0.001).With the increase of the severity of HIE,the peak and abnormal ratio of ALB gradually decreased,while the peak of PT and PTT gradually increased(P<0.001).Compared with the normal temperature treatment group,the peak times of ALT,AST,ALB and CRP in the mild hypothermia treatment group were all prolonged(P<0.05),while the peak times of PT and PTT in the two groups were not significantly different(P>0.05).Compared with the normal temperature treatment group,the moderate and severe HIE neonates in the mild hypothermia treatment group had significantly lower peaks for ALT,AST and CRP levels,while ALB increased significantly,and the abnormal proportions of ALT,ALB and CRP also had the same trend(P<0.05).There was no significant difference in PT and PTT levels and abnormal ratio between the two groups(P>0.05).Conclusion Mild hypothermia treatment can effectively reduce the peaks and abnormal proportions of ALT,ALB and CRP in HIE newborns,and prolong their peak times.These three indicators can be used to reflect the liver protection effect of mild hypothermia among newborns.

关 键 词：新生儿缺氧缺血性脑病 亚低温 肝损伤生物标志物 丙氨酸氨基转移酶 天冬氨酸氨基转移酶 C反应蛋白 

分 类 号：R722.19[医药卫生—儿科]