sNSE对早期判断新生儿急性胆红素脑病的意义.docVIP

sNSE对早期判断新生儿急性胆红素脑病的意义 　　作者：袁传顺,陈吉庆,徐莉,陈新跃　　作者单位：常州市第七人民医院儿科 　　【摘要】 目的探讨血清神经元特异性烯醇化酶(sNSE) 能否作为早期判断急性胆红素脑病(ABE)的生物学指标。方法 选择高胆红素血症病儿63 例，以24例同期出生的生理性黄疸不明显的足月新生儿作为对照组，测定两组血清总胆红素(TSB)水平，采用电化学发光免疫法测定sNSE水平。结果 不同高胆红素水平的各组sNSE水平比较差异有统计学意义(F=59.813，P0.01)，足月儿sNSE水平与TSB水平间呈显著正相关(r=0.762，P0.01);早产儿组sNSE水平显著高于同等高胆红素水平的足月儿组(F=56.287，q=2.84，P0.05)。结论 高胆红素血症病儿sNSE 水平显著升高，升高程度与TSB水平和早产因素相关。 sNSE较TSB更有可能成为敏感的判断ABE的生物学指标。 　　【关键词】 高胆红素血症,新生儿,核黄疸,磷酸丙酮酸水合酶 　　[ABSTRACT] Objective To explore whether serum neurospecific enolase (sNSE) can be used as a biological indicator for an early diagnosis of acute bilirubin encephalopathy (ABE) in neonates. Methods Sixtythree neonates with hyperbilirubinemia and 24 fullterm newborns without physiologic jaundice were recruited in this study, the latter was served as controls. The levels of sNSE were determined by electrochemiluminescence, and total serum bilirubin (TSB) detected. Results There were significant differences in the level of sNSE among different hyperbilirubinemia babies (F=59.813,P0.01). The level of sNSE was positively correlated with TSB in fullterm newborns (r=0.762,P0.01). In premature group, the level of sNSE was significantly higher than that in the fullterm with samelevel hyperbilirubinemia (F=56.287;q=2.84;P0.05). Conclusion The serum level of sNSE is significantly increased in neonates with hyperbilirubinemia, which is associated with the level of TSB as well as with maturity of the neonates. The sNSE is more likely than TSB to become a sensitive indicator for early diagnosis of ABE. 　　[KEY WORDS] hyperbilirubinemia, neonate; kernicterus; phosphopyruvate hydratase 　　高胆红素血症(高胆)是新生儿期常见的病症。高胆对新生儿的多种脏器损害是客观存在的[13]，其中对神经系统的影响即急性胆红素脑病(ABE) 最为严重、不可逆。换血疗法的出现使绝大多数严重高胆新生儿获得了有效的治疗，然而ABE发病率并没有逐年降低，这与ABE的临床诊断通常依赖临床表现而缺乏客观标准有关。近来有学者报道，脑损伤时血清神经元特异性烯醇化酶(sNSE)有不同程度的升高，而且与脑脊液中NSE之间有显著的相关性[4]。BERGER等[5]认为可以用sNSE筛查婴儿脑损伤。本文通过检测63例高胆新生儿的sNSE水平，旨在探讨sNSE对早期判断新生儿ABE的价值。现将结果报告如下。 　　1 资料与方法 　　1.1 一般资