振幅整合脑电图与NSE在早产儿脑损伤诊断及神经发育预测中的应用  

Application of amplitude-integrated electroencephalograph and NSE in the diagnosis of brain injury and neurodevelopmental prediction in preterm infants

作　　者：孟康康[1] 龚向英[1] 应超[1] MENG Kang-kang;GONG Xiang-ying;YING Chao(Department of Pediatrics,Yiwu Central Hospital,Yiwu,Zhejiang 322000,China)

机构地区：[1]义乌市中心医院儿科,浙江义乌322000

出　　处：《中国妇幼保健》2023年第4期744-747,共4页Maternal and Child Health Care of China

基　　金：浙江省义乌市科研计划项目(20-3-032)。

摘　　要：目的 分析振幅整合脑电图(aEEG)和神经元特异性烯醇化酶(NSE)在早产儿脑损伤诊断及神经发育预测中的应用。方法 选取2020年5月—2021年11月期间在生后24 h内入住义乌市中心医院的97例早产儿为研究对象,均行头颅核磁共振成像(MRI)检测,按照有无异常将其分为脑损伤组(n=32)和非脑损伤组(n=65)。于出生后72 h内行aEEG监测,比较两组早产儿的一般临床资料、aEEG评分、血清NSE水平、新生儿神经行为测定(NBNA)评分,并对aEEG评分、血清NSE与NBNA评分进行相关性分析。采用ROC曲线法判断aEEG评分与血清NSE对早产儿脑损伤的诊断价值。结果 两组患儿的性别、胎龄、出生体质量、分娩方式、是否合并孕期并发症差异均无统计学意义(均P>0.05)。脑损伤组aEEG监测指标中的连续性、睡眠-觉醒周期、下边界振幅、宽带及总分均低于非脑损伤组,差异均有统计学意义(均P<0.05)。脑损伤组的血清NSE水平高于非脑损伤组,NBNA评分均低于非脑损伤组,差异均有统计学意义(P<0.05)。aEEG评分与NBNA评分呈正相关(r=0.258,P=0.011),血清NSE水平与NBNA评分呈负相关(r=-3.000,P=0.003)。aEEG评分诊断效能AUC值为0.891,灵敏度为78.1%,特异度为98.5%;血清NSE水平诊断效能AUC值为0.984,灵敏度为91.9%,特异度为98.5%;两者联合诊断效能AUC值为0.996,灵敏度为93.8%,特异度为100.0%。结论 aEEG及NSE与患儿神经发育情况具有显著相关性,两者在早产儿脑损伤中均具有良好的诊断效能,且两者联合的诊断效能优于单独诊断。Objective Analysis of amplitude-integrated electroencephalograph(aEEG) and neuron-specific enolase(NSE) in the diagnosis of brain injury and its application in neurodevelopmental prediction of preterm infants.Methods A total of 97 premature infants admitted to the Yiwu Central Hospital within 24 h after birth from May 2020 and November 2021 were selected for cranial magnetic resonance imaging(MRI),divided into brain injury group(n=32) and non-brain injury group(n=65) within 72 h, aEEG monitoring within 72 h, comparing the general clinical data, aEEG score, serum NSE level, neonatal NSE determination(NBNA) score, and correlation between aEEG score, serum NSE and NBNA score.The diagnostic value of aEEG score and serum NSE for brain injury in preterm infants was judged by the ROC curve method.Results There were no significant differences in gender, gestational age, birth weight, mode of delivery, or whether the combined pregnancy complications(P>0.05).Continuity, sleep-wake cycle, lower boundary amplitude, broadband and total score in the aEEG monitoring index were lower than in the non-brain injury group, which were statistically significant(P<0.05).Serum NSE levels were higher than non-brain injury groups, and NBNA scores were lower than non-brain injury groups, and statistically significant(P<0.05).A positive correlation between aEEG score and NBNA score(r=0.258,P=0.011) and serum NSE level was negatively correlated with NBNA score(r=-3.000,P=0.003).The aEEG score diagnostic efficacy AUC value of 0.891,sensitivity of 78.1%,specificity of 98.5%,AUC value of 0.984,91.9%,sensitivity of 98.5%,combined diagnostic efficacy AUC value of 0.996,sensitivity of 93.8% and sensitivity of 100.0%.Conclusion The amplitude integrated EEG showed a significant correlation between NSE and pediatric neurodevelopment, both showing good diagnostic efficacy in the diagnosis of brain injury in preterm infants, and the combination was better than the diagnosis alone.

关 键 词：振幅整合图 神经元特异性烯醇化酶 早产儿 脑损伤 

分 类 号：R722.6[医药卫生—儿科]