缺氧缺血性脑病患儿脑脊液β2微球蛋白与疾病严重程度及亚低温治疗结局的关系  

Relationship between cerebrospinal fluidβ2 microglobulin in hypoxic ischemic encephalopathy and disease severity and outcome of therapeutic hypothermia

作　　者：吉张艳 王红霞[2] 邝少丹 JI Zhangyan;WANG Hongxia;KUANG Shaodan(Neonatology Department,Dongfang People’s Hospital,Dongfang,Hainan 572600,China;Department of Neonatology,Central South University Xiangya School of Medicine Affiliated Haikou Hospital,Haikou,Hainan 570208,China)

机构地区：[1]东方市人民医院新生儿科,海南东方572600 [2]中南大学湘雅医学院附属海口医院新生儿科,海南海口570208

出　　处：《中国优生与遗传杂志》2023年第10期2087-2093,共7页Chinese Journal of Birth Health & Heredity

基　　金：海南省卫生健康行业科研项目(18A200143)。

摘　　要：目的 分析缺氧缺血性脑病(HIE)患儿脑脊液β2微球蛋白(CSF-β2M)与疾病严重程度及亚低温治疗(TH)后神经发育结局的关系。方法 纳入2020年5月至2022年7月在东方市人民医院新生儿科出生的HIE新生儿(HIE组)及CSF培养阴性的新生儿(对照组)各59例。采用自动化学发光免疫分析法测定出生后12~72 h CSF-β2M。进行连续振幅整合脑电图(aEEG)、磁共振成像(MRI)检查。中重度HIE患儿接受TH,使用贝莉婴幼儿发育量表-第3版(BSID-III)评估24个月时神经发育结局,将神经发育不良结局定义为死亡、脑性瘫痪或BSID-III评分<85分。结果 HIE患儿CSF-β2M水平显著高于对照组[6.42(3.63,10.04)mg/L vs 3.50(2.44,6.24)mg/L,P<0.001],且中重度HIE患儿较轻度HIE患儿CSF-β2M水平进一步升高(P<0.001)。与无异常神经症状的HIE患儿相比,有异常神经症状(包括癫痫发作、aEEG背景活动异常和MRI中重度脑损伤)的HIE患儿CSF-β2M水平普遍较高(P<0.001)。对于接受TH的中重度患儿(n=41),30例(73.17%)患儿神经发育不良,且这部分患儿CSF-β2M水平均高于具有良好结局的患儿[8.90(7.33,10.71)mg/L vs 5.87(4.27,6.56)mg/L,P=0.019]。而且经多因素Logistic回归分析,CSF-β2M>6.42mg/L是影响接受TH的中重度患儿神经发育结局的独立危险因素(OR=125.238,95%CI:2.195~7146.347,P=0.019)。结论 检测出生后72h内HIE患儿的CSF-β2M可能是评估疾病严重程度及预测TH后神经发育结局的一个有用工具。Objective To analyze the relationship between cerebrospinal fluidβ2 microglobulin(CSF-β2M)and the severity of hypoxic ischemic encephalopathy(HIE)and neurodevelopmental outcomes following therapeutic hypothermia(TH).Methods From May 2020 to July 2022,59 neonates with HIE(HIE group)born in Neonatology Department of Dongfang People’s Hospital and 59 neonates with negative CSF culture(control group)were included.Automatic chemiluminescence immunoassay was used to measure CSF-β2M during 12‒72 h after birth.Amplitude-integrated electroencephalography(aEEG)and magnetic resonance imaging(MRI)were performed.Neonates with moderate to severe HIE received TH,and neurodevelopmental outcomes at 24 months were assessed using the Bayley scales of infant and toddler development edition III(BSID-III).Neurodevelopmental outcomes were defined as death,cerebral palsy,or BSID-III<85.Results The CSF-β2M level in neonates with HIE was significantly higher than that in control group[6.42(3.63,10.04)mg/L vs 3.50(2.44,6.24)mg/L,P<0.001],and the CSF-β2M level in neonates with moderate to severe HIE was higher than that in neonates with mild HIE(P<0.001).Neonates with HIE with abnormal neurological symptoms(including seizures,abnormal aEEG background activity,and moderate to severe brain injury on MRI)had generally higher CSF-β2M levels than those without abnormal neurological symptoms(P<0.001).Among the 41 moderate to severe neonates(n=41)who received TH,30(73.17%)had neurodysplasia,and the CSF-β2M level in these neonates was higher than that in the neonates with good outcome[8.90(7.33,10.71)mg/L vs 5.87(4.27,6.56)mg/L,P=0.019].Multivariate Logistic regression analysis showed that CSF-β2M>6.42 mg/L was an independent risk factor for neurodevelopmental outcomes in moderate to severe neonates receiving TH(OR=125.238,95%CI:2.195-7146.347,P=0.019).Conclusion Detection of CSF-β2M within 72 hours after birth in neonates with HIE may be a useful tool to evaluate the severity of the disease and predict the neurodevelopmental outcome a

关 键 词：亚低温治疗 缺氧缺血性脑病 Β2微球蛋白 脑脊液 神经发育结局 

分 类 号：R742[医药卫生—神经病学与精神病学]