缺血缺氧脑病患儿脑血流动力学及脐血BNP、NGF、NSE水平研究

摘要

目的 探讨缺血缺氧脑病(HIE)患儿脑中央动脉血流动力学变化,并分析患儿脐血脑钠肽(BNP)、神经生长因子(NGF)、神经特异性烯醇化酶(NSE)水平和神经评定(NBNA)评分的相关性.方法 选取2015年6月至2016年5月宜宾市第二人民医院儿科收治的45例HIE新生儿(观察组)和33例健康新生儿(对照组)为研究对象,采用彩色多普勒检测脑中央动脉血流动力学指标,采用酶联免疫吸附实验(ELISA)法检测脐血BNP、NGF、NSE水平,分析HIE新生儿脐血BNP、NGF、NSE水平与NBNA评分的相关性.结果 观察组患儿脑动脉中央支平均峰流速(Vm)为(9.28±2.57)cm/s,阻力指数(RI)为(0.62±0.11),对照组脑动脉中央支Vm为(13.74±2.38)cm/s,RI为(0.48±0.09),两组比较差异均具有统计学意义(P<0.05);观察组患儿脐血BNP、NGF及NSE水平分别为(268.51±67.11)ng/L、(174.72±18.34)ng/L和(87.78±23.56)μmol/L,观察组患儿NBNA评分为(34.81±5.86)分;对照组患儿脐血BNP、NGF及NSE水平分别为(139.73±44.86)ng/L、(218.48±19.89)ng/L和(20.03±5.43)μmol/L,NBNA评分为(38.43±2.61)分,两组比较差异均具有统计学意义(P<0.05);观察组患儿脐血BNP、NSE水平与NBNA评分呈显著负相关(r=-0.416,-0.381,P<0.05),而NGF水平与NBNA评分呈显著正相关(r=0.321,P<0.05);对照组新生儿脐血BNP、NSE及NGF水平与NBNA评分均无明显相关性(r=-0.336、0.236、-0.162,P>0.05).结论 脑中央动脉血流动力学和脐血BNP、NGF、NSE水平对HIE的诊断和病情判断具有重要价值,临床上可根据具体情况进行监测随访.%Objective To explore the change of cerebral hemodynamics of middle cerebral artery in neonatal hypoxic-ischemic encephalopathy (HIE) and analyze the correlation of umbilicus blood brain natriuretic peptide (BNP), nerve growth factor (NGF), neuronal specific enolase (NSE) levels and neonatal behavioral neurological assessment (NBNA) score. Methods A total of 45 newborn infants with HIE (observation group) and 33 healthy newborn infants in Department of Pediatrics of Yibin Second People's Hospital from Jun. 2015 to May 2016 were enrolled in this study. The cerebral hemodynamics of middle cerebral artery was detected by color Doppler ultrasound, and the levels of umbili-cus blood BNP, NGF, NSE were detected by enzyme-linked immunosorbent assay (ELISA). The correlation of BNP, NGF, NSE levels and NBNA scores was analyzed. Results The mean velocity (Vm) of middle cerebral artery and resis-tance index (RI) were respectively (9.28 ± 2.57) cm/s and (0.62 ± 0.11) in the observation group versus corresponding (13.74±2.38) cm/s and (0.48±0.09) in the control group (P<0.05). The levels of BNP, NGF, NSE and NBNA score were respectively (268.51 ± 67.11) ng/L, (174.72 ± 18.34) ng/L, (87.78 ± 23.56) μmol/L and (34.81 ± 5.86) in the observation group versus corresponding (139.73 ± 44.86) ng/L, (218.48 ± 19.89) ng/L, (20.03 ± 5.43)μmol/L and (38.43 ± 2.61) in the control group (P<0.05). There was a negative correlation between the levels of BNP, NSE and NBNA score (r=-0.416,-0.381;P<0.05) and a positive correlation between the level of NGF and NBNA score (r=0.321, P<0.05) in the observation group. There was no significant correlation between the levels of BNP, NSE, NGF and NBNA score in the control group (r=-0.336, 0.236,-0.162;P>0.05). Conclusion Cerebral hemodynamics of middle cerebral artery and the levels of BNP, NGF, NSE in umbilicus blood are important in clinical diagnosis and evaluating the severity of HIE.