新生儿缺氧缺血性脑病血清心肌型脂肪酸结合蛋白的变化及临床价值.doc

　　新生儿缺氧缺血性脑病血清心肌型脂肪酸结合蛋白的变化及临床价值 ：许新梅 杜娟 章建英 周彦 黄海波 王静 【摘要】 目的 探讨血清心肌型脂肪酸结合蛋白（H-FABP）定量测定对新生儿缺氧缺血性脑病（HIE）患儿合并心肌损害的临床应用价值。方法 HIE组新生儿35例，正常对照组新生儿15例。正常对照组于生后1天，HIE组分别于生后1天(急性期)及第7天（恢复期）抽股静脉血4 ml，检测H-FABP和心肌型肌酸激酶同工酶（CK-MB)水平。结果 急性期HIE组血清H-FABP和CK-MB水平均明显高于正常对照组（P＜0.01）；恢复期轻、中度HIE患儿血清H-FABP和CK-MB水平均明显下降，与正常对照组差异无显著性（P＞0.05），重度HIE患儿血清CK-MB水平与正常对照组比较差异也无显著性（P＞0.05），而重度HIE患儿血清H-FABP水平明显高于正常对照组（P＜0.01）。且血清H-FABP的浓度可随HIE的病情程度而相应变化。急性期HIE患儿血清H-FABP与CK-MB的阳性率分别为：H-FABP　94.3%，CK-MB　42.9%,差异有显著性（P＜0.01）。急性期HIE患儿检测血清H-FABP的敏感性高于血清CK-MB。结论 H-FABP是一种微小心肌损害高敏感的指标，对筛查HIE患儿有无合并心肌损害、指导治疗及判断HIE的病情严重程度及预后具有重要的应用价值。 【关键词】 缺氧缺血性脑病; 新生儿；心肌损害；心肌型脂肪酸结合蛋白 Abstract:Objective To explore the clinical value of the heart-type fatty acid binding protein （H-FABP）in neonatal hypoxic-ischemic encephalopathy（HIE）.Methods Peripheral venous blood samples (4 ml each) 35 neonates 15 normal neonates (normal control) 1 day after birth. Serum H-FABP and myocardial-specific isoenzyme of creatine kinase (CK-MB) levels easured.Results During the acute period in HIE group, the levels of serum H-FABP and CK-MB al control (P＜0.01). In recovery period, serum H-FABP and CK-MB dropped to normal level in slight/mid HIE neonates pared to normal control (P＞0.05); CK-MB also dropped to normal level in severe HIE neonates pared to normal control (P＞0.05); but in the severe HIE neonates the level of serum H-FABP al control (P＜0.01). In addition, the levels of serum H-FABP varied H-FABP being higher than that of serum CK-MB (P＜0.01）. Conclusion H-FABP is a sensitive index of mini myocardial damage. It can be used as a test for screening myocardial damage in HIE neonates, guiding the treatment of HIE and evaluating its severity and prognosis. Key ic encephalopathy; neonate； myocardial damage； heart-type fatty acid binding protein 新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy, HIE）是新生儿期常见病之一，病情重，预后差，可同时合并心肌损害。临床上，HIE合并心肌损害有报道达96.2%［1］。血清心肌型脂肪酸结合蛋白（heart-type fatty acid binding protein，H-FABP）是一种重要的细胞内脂肪酸载体蛋白，相对分子质量小（14