不同检测指标在预测高胆红素血症新生儿胆红素脑损伤的比较

摘要

Objective: To explore and compare the difference indicators of Neuron-Specific Enolase (NSE), Total Serum Bilirubin (TSB), ratio of TSB and albumin (B/A) in serum with brain damage in neonatal hyperbilirubinemia, to analyze these indicators to predict brain damage in neonatal hyperbilirubinemia. Method: 47 full-term newborns with hyperbilirubinemia age 1-7 days were divided into two groups by Brainstem Auditory Evoked Potential (BAEP), the BAEP normal group (BNP) and the BAEP abnormal group (BAP). The serum NSE levels was tested by enzyme-linked immunosorbent assay; TSB (B) was detected by diazo assay, albumin (A) was tested by method of bromocresol green and B/A value was calculated. The correlation of TSB, NSE, B/A value with BAEP were compared by Receiver Operator Characteristic Curve (ROCC).Result: (1) The TSB, NSE, B/A of the BAEP abnormal group were (303.07±51.77)μmol/L, (124.28±33.06)μg/L,(6.65±2.53)×10-3; the the BAEP normal group were (296.20±46.87)μmol/L, (65.41±20.96)μg/L, (4.20±1.99)×10-3. The the BAEP abnormal group were higher than the normal group in NSE and B/A, there were statistical significance (P<0.01), but in TSB there was no statistical significance of the two groups (P>0.05). (2) The BAEP as the gold standard, sensitivity of TSB, NSE, B/A values were 84.33%, 75.10%, 45.31%, specificity were 65.18 %, 76.23%, 49.06%. NSE and B/A values were significantly higher in sensitivity and specificity than TSB, the differences had statistical significance (P=0.005). NSE was the highest sensitivity and B/A was the best specificity. (3) NSE, B/A value prediction of neonatal hyperbilirubinemia hearing damage critical point were 100.56 μg/L, 6.06×10-3.Conclusion: The sensitivity and specificity in serum NSE and B/A values are higher than TSB. NSE and B/A values may be used as indicators to predict brain damage in neonatal hyperbilirubinemia.%目的：观察并比较患高胆红素血症新生儿在伴脑损伤情况下，血清神经元特异性烯醇化酶（NSE）、总胆红素（TSB）水平及总胆红素与白蛋白比值（B/A）的差异，分析上述检测指标在预测高胆红素血症新生儿发生胆红素脑损伤中的优劣。方法：选择日龄1~7 d内的足月高胆红素血症新生儿47例进行脑干听觉诱发电位（BAEP）检测，并依据检测结果分为BAEP正常组和BAEP异常组。酶联免疫吸附法检测患儿血清NSE水平，重氮法检测TSB（B），溴甲酚绿法检测白蛋白（A）并计算B/A值；受试者工作曲线（ROCC）。比较TSB、NSE、B/A值等检测指标与BAEP法的相关性。结果：（1）BAEP异常组的TSB、NSE、B/A值分别为（303.07±51.77）μmol/L、（124.28±33.06）μg/L、（6.65±2.53）×10-3，BAEP正常组分别为（296.20±46.87）μmol/L、（65.41±20.96）μg/L、（4.20±1.99）×10-3；两组TSB值比较差异无统计学意义（P>0.05），但NSE、B/A值的比较差异均有统计学意义（P<0.01）；（2）以BAEP法为金标准，TSB、NSE、B/A值的敏感性分别为84.33%、75.10%、45.31%，特异性分别为65.18%、76.23%、49.06%；NSE、B/A值的敏感性与特异性均显著高于TSB，差异均有统计学意义（P=0.005）；NSE检测的敏感性最高，而B/A值的特异性最高。（3）NSE、B/A值预测胆红素血症新生儿听力损害的临界点分别为100.56μg/L、6.06×10-3。结论：测定血清中NSE及B/A值的敏感性及特异性均高于TSB，可作为预判新生儿高胆红素血症发生脑损伤的指标。