脑脊液NSE水平与新生儿HIE患儿脑损伤严重程度、小脑及脑干ADC值的关系  

The relationship between the level of NSE in cerebrospinal fluid and the severity of brain injury,the ADC value of cerebellum and brainstem in neonates with HIE

作　　者：尤一军 董秋菊 尹志芳 YOU Yijun;DONG Qiuju;YIN Zhifang(Department of Medical Genetics and Prenatal Screening,Handan Maternal and Child Health Hospital,Handan Hebei 056001,China)

机构地区：[1]邯郸市妇幼保健院医学遗传与产前筛查科,河北邯郸056001 [2]邯郸市妇幼保健院医学中医科,河北邯郸056000

出　　处：《中国急救复苏与灾害医学杂志》2024年第5期657-662,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省邯郸市科学技术研究与发展计划项目(编号:19422083043ZC)。

摘　　要：目的探索脑脊液(CSF)神经元特异性烯醇化酶(NSE)与新生儿缺氧缺血性脑病(HIE)脑损伤严重程度、小脑以及脑干表观扩散系数(ADC)的关系。方法在2019年3月—2021年5月选择了43例出生后6 h内确诊的HIE患儿和经59例非HIE新生儿(对照组)作为研究对象。研究NSE与HIE、脑损伤严重程度和ADC的关系。结果HIE患儿CSFNSE显著高于对照组[78.0(52.50,203.00)ng/mL vs.32.0(24.0,57.0)ng/mL,Z=-5.360,P<0.001];在轻度、中度和重度HIE患儿中CSFNSE水平分别为34.0(25.0,72.0)ng/mL、72.0(58.75,76.75)ng/mL、220.50(120.50,368.75)ng/mL,三组具有统计学意义(H=26.511,P<0.001)。CSFNSE与左小脑半球ADC值呈负相关(rs=-0.604,P<0.001),与小脑蚓部、延髓ADC(rs=0.396、0.323,P<0.05)呈正相关。预后不良组的NSE在中或重度脑病、死亡、不良结局、左小脑ADC<3.40×10-3 mm2/s的患者中的水平显著升高(P<0.05)。经Logistic回归模型分析,NSE水平是影响HIE发生和疾病严重程度的独立性因素。CSFNSE预测HIE、HIE发生不良结局和HIE死亡的截断值分别为69.000 ng/mL、220.500 ng/mL和267.500 ng/mL。结论出生后72 h内CSF样本中高水平NSE与HIE患儿疾病进展和存活婴儿24月时神经发育结局关系显著,且与左小脑半球、小脑蚓部、延髓的ADC存在显著相关性。Objective This study was to investigate the relationship between cerebrospinal fluid(CSF)neuron-specific enolase(NSE)levels,injury severity,and apparent diffusion coefficient(ADC)of the cerebellum and brainstem in the treatment of neonatal hypoxic-ischemic encephalopathy(HIE).Methods Between March 2019 and May 2021,43 children with HIE diagnosed within 6 hours of birth and 59 non-HIE neonates(control group)were selected as study subjects.The relationship between NSE and HIE,HIE disease severity and ADC was studied.Results The CSF NSE of HIE patients was significantly higher than that of the control group[78.0(52.50,203.00)ng/mL vs.32.0(24.0,57.0)ng/mL,Z=-5.360,P<0.001].In children with mild,moderate and severe HIE,the levels of CSF NSE were 34.0(25.0,72.0)ng/mL,72.0(58.75,76.75)ng/mL,and 220.50(120.50,368.75)ng/mL,respectively,which were statistically significant in the three groups(H=26.511,P<0.001).CSF NSE showed a negative correlation with ADC values of the left cerebellar hemisphere(rs=-0.608,P<0.001),and a positive correlation with the cerebellar vermis and medulla oblongata ADC(rs=0.396,0.323,P<0.05).Elevated NSE levels were associated with moderate or severe encephalopathy,death,adverse outcomes,and left cerebellar ADC<3.40×10-3 mm2/s(P<0.05).Logistic regression analysis showed that NSE levels were independent factors influencing the occurrence and severity of HIE.The cut-off values for CSF NSE prediction of HIE,adverse outcomes and HIE mortality were 69.000 ng/mL,220.500 ng/mL and 267.500 ng/mL,respectively.Conclusion High CSF NSE levels within 72 hours after birth were significantly correlated with disease progression and neurodevelopmental outcomes at 24 months in children with HIE there was a significant correlation between ADC and ADC of the left cerebellar hemisphere,cerebellar vermis and medulla oblongata.

关 键 词：神经元特异性烯醇化酶 缺氧缺血性脑病 脑损伤严重程度 表观扩散系数 磁共振 

分 类 号：R651.15[医药卫生—外科学]