脐血S100β蛋白及乳酸联合振幅整合脑电图对小于胎龄早产儿脑损伤的早期预测研究  

The early prediction of umbilical cord blood S100βprotein and lactate combined with amplitude integrated electroencephalogram in small for gestational age preterm infants with brain injury

作　　者：陈俊龙 王小丽 杨晓玲 苏学文 贾富华 武书丽 Chen Junlong;Wang Xiaoli;Yang Xiaoling;Su Xuewen;Jia Fuhua;Wu Shuli(Department of Neonatology,Inner Mongolia People's Hospital,Huhhot 010017,China;Department of Outpatient,Inner Mongolia People's Hospital,Huhhot 010017,China;Department of Pediatrics,Inner Mongolia People's Hospital,Huhhot 010017,China)

机构地区：[1]内蒙古自治区人民医院新生儿科,呼和浩特010017 [2]内蒙古自治区人民医院门诊部,呼和浩特010017 [3]内蒙古自治区人民医院儿科,呼和浩特010017

出　　处：《国际儿科学杂志》2024年第1期64-68,共5页International Journal of Pediatrics

基　　金：内蒙古自治区卫健委科技计划项目(202201046, 202202018);内蒙古医科大学联合项目(YKD2023LH078)。

摘　　要：目的探讨脐血S100β蛋白及乳酸联合振幅整合脑电图(amplitude integrated electroenceph-alogram,aEEG)对小于胎龄儿(small for gestational age,SGA)早产儿脑损伤的早期预测价值。方法选取内蒙古自治区人民医院新生儿科自2019年1月至2021年12月收治的106例SGA早产儿为研究对象,所有患儿于出生时采集脐带血完善血清S100β蛋白及乳酸检测,同时于生后6 h、生后72 h、矫正胎龄32周及矫正胎龄37周完善aEEG监测,根据早产儿脑损伤诊断标准,将SGA早产儿分为脑损伤组(45例)和非脑损伤组(61例),比较两组患儿脐血血清S100β蛋白、乳酸及不同时间点aEEG的差异;将脑损伤的SGA早产儿分为匀称型组(28例)和非匀称型组(15例),比较两类患儿脐血S100β蛋白及乳酸水平差异,研究两者在不同类型SGA早产儿脑损伤中的诊断价值。结果 SGA早产儿脑损伤组脐血S100β蛋白水平[(0.826±0.218)μg/L]和乳酸水平[(8.5±1.3)mmol/L]较非脑损伤组[(0.397±0.196)μg/L和(3.8±0.9)mmol/L]均明显增高(t=8.316、3.281,均P<0.05);匀称型组脐血S100β蛋白水平[(0.924±0.205)μg/L]高于非匀称型组[(0.438±0.196)μg/L](t=5.734,P<0.05),而脐血乳酸水平比较差异无统计学意义[(5.6±1.4)mmol/L比(3.9±1.2)mmol/L,t=0.932,P>0.05]。脑损伤组与非脑损伤组aEEG异常率在生后6 h分别为100%(45/45)与22.95%(14/61)、生后72 h分别为95.56%(43/45)与16.39%(10/61)、矫正胎龄32周分别为62.22%(28/45)与6.56%(4/61)、矫正胎龄37周分别为22.22%(10/45)与3.28%(2/61),同一时间节点脑损伤组异常率均高于非脑损伤组,差异均有统计学意义(χ2值分别为62.292、64.913、38.074、9.257,均P<0.05)。结论脐血S100β蛋白、乳酸水平及aEEG监测结果对SGA早产儿脑损伤的早期诊断均有一定的价值,三者联合可能更有助于SGA早产儿脑损伤的早期诊断和临床及时治疗。Objective To explore the early predictive value of umbilical cord blood S100βprotein and lactate combined with amplitude integrated electroencephalogram(aEEG)in small for gestational age(SGA)preterm infants with brain injury.Methods One hundred and six cases of SGA preterm infants were enrolled in this study in Neonatology Department of Inner Mongolia People's Hospital from January 2019 to December 2021.Umbilical cord blood serum S100βprotein and lactate at birth of All SGA preterm infants were tested,and aEEG was monitored at 6h and 72 h after birth,corrected gestational age of 32 weeks and 37 weeks.According to the diagnostic criteria of brain injury in preterm infants,SGA preterm infants were divided into brain injury group(45 cases)and non-brain injury group(61 cases),and compared the differences of S100βprotein,lactate and the designated time aEEG between the two groups.SGA preterm infants with brain injury were further divided into symmetrical group(28 cases)and non-symmetrical group(15 cases).The differences of umbilical cord blood S100βprotein and lactate level between the two groups were compared,and the diagnostic value in different types of SGA preterm infants with brain injury was also compared.Results SGA preterm infants in the brain injury group had significantly higher levels of umbilical cord blood S100βprotein[(0.826±0.218)μg/L vs(0.397±0.196)μg/L,t=8.316,P<0.05]and lactate[(8.5±1.3)mmol/L vs(3.8±0.9)mmol/L,t=3.281,P<0.05]than those in non-brain injury group.Symmetric SGA group had higher level of S100βprotein than the asymmetric SGA group[(0.924±0.205)μg/L vs(0.438±0.196)μg/L,t=5.734,P<0.05].But there was no statistically significant difference in lactate levels[(5.6±1.4)mmol/L vs(3.9±1.2)mmol/L,t=0.932,P>0.05]between symmetric SGA group and asymmetric SGA group.The abnormal rates of aEEG in brain injury group and non-brain injury group were respectively 100%(45/45)vs 22.95%(14/61)at 6 h after birth,95.56%(43/45)vs 16.39%(10/61)at 72 h after birth,62.22%(28/45)vs 6.56%(4/61)at

关 键 词：脐血 早产儿 小于胎龄儿 S100Β蛋白 乳酸 振幅整合脑电图 

分 类 号：R722.6[医药卫生—儿科]