新生儿缺氧缺血性脑病脐血肌酸激酶脑型同工酶及神经元特异性烯醇.docVIP

新生儿缺氧缺血性脑病脐血肌酸激酶脑型同工酶及神经元特异性烯醇 　【摘要】 目的 观察新生儿缺氧缺血性脑病（HIE）时脐血肌酸激酶脑型同工酶（CK-BB）及神经元特异性烯醇化酶（NSE）水平变化，早期诊断新生儿缺氧缺血性脑损伤，为临床早期诊断新生儿缺氧缺血性脑损伤及协助HIE分度、预后评估提供一定的依据。方法 20例足月儿，出生后1 min Apgar评分gt;9分的新生儿为对照组，32例诊断为新生儿缺氧缺血性脑病的新生儿为病例组，生后立即收集脐血，检测CK-BB及NSE值。结果 新生儿HIE组脐血CK-BB及NSE水平明显高于对照组，差异有非常显著性（Plt;0.01）,且与HIE程度呈正相关。结论 新生儿缺氧缺血性脑病组脐血CK-BB及NSE水平高于对照组，差异有显著性。CK-BB、NSE水平变化可作为反映早期脑损伤的生化指标，可协助HIE分度、预后评估，对HIE进行早期干预，具有一定的临床价值。 【关键词】 缺氧缺血性脑病；脐血；神经元特异性烯醇化酶；肌酸激酶脑型同工酶 Dynamic changes and clinical significance of creatinkinase-BB and neuron-specific enolase in cord blood of neonatal hypoxic ischemic encephalopathy ［Abstract］ Objective The research was aimed to study the changes of neuron-specific enolase （NSE）,creatinkinase-BB （CK-BB） in cord blood of newborns with hypoxic ischemic encephalopathy and make out the relationship between hypoxic ischemic encephalopathy （HIE） and the function of throid.Methods There were 20 neonates without the symptoms of fetal distress and Apgar score ≥9 in the control group.There were 32 neonates with HIE in the study group.All neonates were measured for CK-BB and NSE levels in umbilical artery at delivery.Results The results showed that the level of NSE、CK-BB in cord blood of neonates with HIE was significantly higher than normal control（Plt;0.01）.Conclusion The levels of NSE and CK-BB in cord blood are the symbol reflecting the early damages of brain.Our findings suggest that the levels of NSE and CK-BB in cord blood are reliable biochemical markers for early estimates of hypoxic-ischemic brain damage and have great value to judging the stage of HIE correctly. ［Key words］ hypoxic ischemic encephalopathy;cord blood;neuron-specific enolase;creatinkinase-BB 新生儿缺氧缺血性脑病（HIE）是新生儿窒息的严重并发症，可导致脑瘫、癫痫、智力低下等神经系统后遗症［1］。尽管其发病机制尚不十分明确，但亦取得了重要的进展。目前认为HIE是一个多因素介导和参与的过程，缺氧缺血后脑能量代谢衰竭、脑血管自动调节功能受损、兴奋性氨基酸大量释放、细胞内Ca2+超载以及大量氧自由基产生、一氧化氮（NO）、β-内啡肽、中性粒细胞及血小板活性因子等作用，致使神经元损伤、脑细胞凋亡，脑功能不同程度损伤。近年来，多种神经生化标志物如神经原特异性烯醇化酶（NSE）S-100、肌酯激酶脑型同工酶（CK-BB）、胶原纤维酸性蛋白（GFAP）、髓鞘碱性蛋白（MBP）等的应用为此开辟了一个新的局面。NS