【作者】 张晶卉；

【导师】 孙若鹏；

【作者基本信息】 山东大学 ， 儿科学， 2009， 硕士

【摘要】 研究背景新生儿缺氧缺血性脑病(HIE)是指围产期窒息导致脑的缺氧缺血性损害,是我国新生儿急性死亡和慢性神经系统后遗症的重要原因之一,其早发现、早诊断、早干预对降低我国新生儿围生期死亡率及致残率,提高人口质量有很大意义。由于缺血缺氧性脑损伤可导致神经细胞的坏死崩解,细胞浆及细胞器内一些特异的分子释放(如S-100,NSE等),检测这些分子的存在,为HIE的诊断提供了途径。其中神经元特异性烯醇化酶(NSE)是特定存在于神经元细胞和神经内分泌细胞内的一种酶,当上述神经细胞由于缺氧缺血发生死亡,该酶可从细胞内释放出来,脑脊液以及外周血中该酶浓度的升高可作为神经细胞损伤的标志,具有很高灵敏性和一定特异性。新生儿20项行为神经评定(NBNA评分),是我国学者在总结国外新生儿行为神经功能评定方法的基础上,发展的一套适合在我国开展并已得以广泛应用的神经行为评估方法,对新生儿缺氧缺血性脑病患儿病情及预后的评估和预计有显著意义。目的本研究旨在探讨新生儿缺氧缺血性脑病中血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)及新生儿20项行为神经评定(Neonatal BehaviralNeurological Assessment,NBNA)的变化、二者与HIE的临床表现分度的关系,以及二者之间的相关性,为HIE早期诊断和病情评估提供依据。方法选取50例新生儿为研究对象,其中HIE患儿40例为实验组,足月儿按国内统一的标准进行诊断和临床表现分度,早产儿中有明确围生期缺氧缺血病史,生后有典型神经系统异常表现者诊断为HIE,并参照国内相关文献进行临床分度;同期分娩的非HIE新生儿10例做为对照组。研究对象均选择合适的时间采血查血清NSE值,并进行NBNA评分。排除可引起NSE升高的其他疾病。用统计分析的方法,分别比较两组中足月儿和早产儿各自不同临床表现组的血清NSE值变化和NBNA评分的差异,观察上述两项指标是否与HIE的临床分度一致,各临床分度间上述两项指标各自差异是否显著。并研究血清NSE值与NBNA评分的相关性。结果随着临床表现程度的加重,足月儿血清NSE值呈现逐渐增高,而NBNA评分逐渐降低。NSE值、NBNA评分在对照组与各实验组之间差异明显(P＜0.05);随着临床表现程度的加重,早产儿血清NSE值也呈现逐渐增高,而NBNA评分逐渐降低。中、重度组HIE早产儿NSE值、NBNA评分之间、及各自较对照组差异显著(P＜0.05),但轻度HIE组患儿NSE值、NBNA评分较对照组差异不明显(P＞0.05)。此外,早产儿血清NSE值与NBNA评分之间有较好的相关性(r=-0.72576),可建立回归方程:Y=888.66615-22.18736X(X为NBNA评分值,Y为NSE监测值)。结论血清NSE值及NBNA评分均是反映HIE及其神经功能损伤的敏感指标,且与临床表现分度基本一致。两指标之间也存在一定相关性,临床可通过对两指标的测定对HIE进行早期诊断与评估。更多还原

【Abstract】 BackgroundNeonatal hypoxic ischemic encephalopathy(HIE) refers to the hypoxic and ischemic brain injury after perinatal asphyxia,which plays an important role in neonatal acute death and chronic sequelae in our country.It is of great significance to give early detection,diagnosis and intervention in degrading the mortality and disability rate of the perinatal stage and elevating the population quality.Because of the necrosis and disaggregation of the neurocyte,some special molecules(such as S-100,NSE,et al) are released by the cytoplasm and organelle.It provides an effective way for HIE diagnosis to detect the existence of these molecules. Neuron-specific enolase(NSE) is an enzyme that specialized located in the neuron cells and the neural endocrine cells.The enzyme can be released from these cells after their death induced by hypoxic ischemic injury.It is a sign of neurocytic injury that the concentration of this enzyme evaluating in cerebrospinal fluid and peripheral circulation, with high sensitivity and certain specificity.Neonatal Behaviral Neurological Assessment(NBNA) is a system of behaviral neurological assessment that develops from foreign behaviral neurological assessments and it is suitable for widely practicing in our country.It is also of great significance to undertake behaviral neurological assessment in evaluating the condition and the prognosis of the neonates.PurposeTo investigate the variance of the serum neuron-specific enolase(NSE) level and the Neonatal Behaviral Neurological Assessment(NBNA) score of the HIE neonates,and the relation between the clinical graduation and the both above,which may provide the evidence for evaluation and early diagnosis of the disease.Methods50 neonates are brought into the research,including 10 normal ones for control group and 40 HIE ones for experimental group,in which term neonates are diagnosed and graduated by domestic unified standards,and preterm ones are diagnosed by their precise hypoxic and ischemic history.All the research objects are obtained blood samples for NSE detecting and proceeded NBNA on proper time,expelled other interference diseases.Statistics analysis is used to determine the differences of NSE levels and NBNA scores between each group.Full term neonates and pre-term ones are compared individually.The concordance between the index above and clinical graduating and the dependablity between the HIE levels and NBNA scores are also determined.ResultsIn full term neonates,as the aggravation of the degree of HIE,the serum NSE levels get increased and NBNA scores get decreased.There are significant differences of NSE levels and NBNA scores between the control group and experimental group(P＜0.05). There are also significant differences of NSE levels and NBNA scores between each degree of the experimental group(P＜0.05).It indicates that in preterm neonates,as the aggravation of the clinical manifestation degree,the serum NSE levels get increased and the NBNA scores get decreased.Compared with the control group,the NSE levels and NBNA scores of the moderate and the severe HIE group have significant differences and there are also significant differences between the two groups(P＜0.05).However,the differences of the two indexes between the mild HIE group and the control group is not significant(P＞0.05).In preterm neonates,serum NSE levels have good dependability with NBNA scores(r=-0.72576):Y=888.66615-22.18736 X(X=NBNA score,Y=NSE level)ConclusionSerum NSE level and NBNA score are sensitive index of HIE and its neurological injury.And they are concordance with the clinical manifestation degrees.There are correlations between the two indexes.We can perform early diagnosis and evaluation of HIE by utilization of the two indexes.更多还原