心肌做功指数在早期评价缺氧缺血性脑病新生儿心肌及神经损伤中的价值

摘要

目的 探讨心肌做功指数(MPI)在早期评价缺氧缺血性脑病(HIE)新生儿心肌及神经损伤中的价值.方法 选择HIE患儿98例,其中轻度组31例、中度组34例、重度组33例,选择正常分娩的健康新生儿100例作为对照组.应用彩色多普勒超声诊断仪测定各组新生儿左心室、右心室MPI,并检测心肌损伤指标[N端脑利钠肽前体(NT-proBNP)、肌红蛋白(Myo)、心肌营养素-1(CT-1)、糖原磷酸化酶同工酶BB(GPBB)]含量、血清神经损伤指标[神经胶质酸性蛋白(GFAP)、泛素羧基末端水解酶 L1(UCH-L1)、髓磷脂碱性蛋白(MBP)、神经营养因子(NTF)、神经元特异性烯醇化酶(NSE)]含量以及血清神经凋亡指标[半胱氨酸天冬氨酸蛋白水解酶3(Caspase-3)、B淋巴细胞瘤-2(Bcl-2)、Bcl-2相关X蛋白(Bax)]含量.采用Spearman相关分析MPI与心肌损伤、神经损伤指标的相关性.结果 重度组、中度组、轻度组和对照组左心室及右心室MPI、外周血NT-proBNP、Myo、CT-1、GPBB含量及GFAP、UCH-L1、MBP、NSE、Caspase-3、Bax含量均依次降低(均P<0.05),而血清NTF、Bcl-2含量依次升高(P<0.05).Spearman相关分析结果显示,HIE患儿MPI与NTF及Bcl-2呈负相关(均P<0.05),与其他心肌损伤、神经损伤、神经凋亡指标含量均呈正相关(均P<0.05).结论 HIE患儿的MPI较高,与患儿的心肌、神经损伤相关,对早期判断HIE患儿心肌损伤有较高价值.%Objective To explore the value of myocardial performance index(MPI) in the early evaluation of myocardial damage and nerve injury among neonates with hypoxic-ischemic encephalopathy(HIE).Methods Ninety-eight children with HIE consisted of 31 in the mild group,34 in the moderate group and 33 in the severe group,and 100 healthy newborns of normal delivery as control group.Color Doppler ultrasonography was used to determine the neonatal left and right ventricular MPI. The contents of myocardial damage indexes, including N-terminal pro-brain natriuretic peptide(NT-proBNP),myoglobin(Myo),cardiotrophin-1(CT-1) and glycogen phosphorylase isoenzyme BB(GPBB),the serum contents of nerve injury indexes,including glial fibrillary acidic protein(GFAP),ubiquitin carboxy-terminal hydrolases L1(UCH-L1),myelin basic protein(MBP),neurotrophic factor(NTF) and neuron-specific enolase(NSE),and the serum contents of nerve apoptosis indexes,including cysteinyl aspartate specific proteinase 3(Caspase-3),B-cell lymphoma-2(Bcl-2) and Bcl-2 associated X protein(Bax),were detected.The Spearman correlation analysis was used to assess the correlation of MPI with myocardial damage and nerve injury. Results The left and right ventricular MPIs,the peripheral blood contents of NT-proBNP,Myo,CT-1 and GPBB,and the contents of GFAP,UCH-L1,MBP,NSE,Caspase-3 and Bax decreased in turn in the severe group,moderate group,mild group and control group(P<0.05).The serum contents of NTF and Bcl-2 increased in turn in the severe group,moderate group,mild group and control group(P<0.05).The result of Spearman correlation analysis showed that MPI negatively correlated with NTF and Bcl-2 (all P<0.05),but positively correlated with the contents of other myocardial damage,nerve injury and nerve apoptosis indexes among neonates with HIE(all P<0.05).Conclusion MPI is quite high among neonates with HIE,which correlates with myocardial damage and nerve injury of the neonates,and it is valuable in the judgment of myocardial damage among the neonates with HIE in early stage.