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目的:探讨经颅彩色多普勒超声联合血清神经元特异性烯醇化酶(NSE)在新生儿缺血缺氧性脑病(HIE)早期诊断中的应用。方法:选取我院收治的42例HIE患儿作为研究组,另选同期出生30例健康新生儿为对照组;采用酶联法检测两组新生儿血清NSE水平,经颅超声检查其脑血流动力学Vd、Vs及RI值,并通过采用ROC曲线进行分析血清NSE水平和经颅超声监测脑血流动力学Vd、Vs及RI值及联合诊断HIE的准确性和特异性。结果:对照组新生儿出生后6h、12h及24h血清NSE水平均无明显差异(P>0.05),研究组出生后6h血清NSE水平明显高于出生后24h(P<0.05);同时研究组各时间点NSE水平均显著高于对照组(P<0.001);对照组新生儿出生后6h、12h及24h的Vd、Vs及RI值比较无明显差异(P>0.05),且研究组各时间点Vs、RI值均显著高于对照组,Vd显著低于对照组(P<0.001);ROC曲线显示,在HIE患儿出生后12h血清NSE诊断预测HIE的特异度和灵敏度最高,分别为71.2%和100%;经颅超声监测Vd、Vs及RI诊断预测HIE的灵敏度、特异度以出生后6h最高,分别为91.3%、89.7%,90.8%和88.6%,94.8%、91.2%;而血清HSE和经颅超声联合诊断出生6h后HIE的灵敏度和特异度最高,为100%和96.1%。结论:经颅彩色多普勒超声联合血清NSE检测可有效提高对HIE诊断预测的灵敏度和特异性度,可为HIE早期诊断提供依据。
Objective: To investigate the application of transcranial color Doppler ultrasound combined with serum neuron-specific enolase (NSE) in the early diagnosis of neonatal hypoxic-ischemic encephalopathy (HIE). Methods: Forty-two children with HIE admitted to our hospital were selected as the study group and 30 healthy newborn children were selected as the control group. Serum NSE levels were measured by enzyme-linked immunosorbent assay (ELISA) and transcranial ultrasound Kinetics of Vd, Vs and RI values, and through the use of ROC curve analysis of serum NSE levels and transcranial ultrasound monitoring of cerebral hemodynamics Vd, Vs and RI values and combined diagnosis of HIE accuracy and specificity. Results: There was no significant difference in serum NSE levels at 6h, 12h and 24h after birth in the control group (P> 0.05). The level of NSE in the study group at 6h after birth was significantly higher than that at 24h after birth (P <0.05) The levels of NSE at the time points were significantly higher than those in the control group (P <0.001). There was no significant difference in the values of Vd, Vs and RI at 6h, 12h and 24h after birth in the control group (P> 0.05) Vs and RI were significantly higher than those in the control group (P <0.001). The ROC curve showed that the specificity and sensitivity of serum NSE at 12 h after birth in HIE children were 71.2% And 100%, respectively. The sensitivity and specificity of transcranial ultrasonography for the diagnosis of HIE with Vd, Vs and RI were 91.3%, 89.7%, 90.8% and 88.6%, 94.8% and 91.2%, respectively. The specificity of serum HSE And transcranial ultrasound diagnosis of 6h after birth, the highest sensitivity and specificity of HIE, 100% and 96.1%. Conclusion: Transcranial color Doppler ultrasound combined with serum NSE detection can effectively improve the sensitivity and specificity of HIE diagnosis and prediction, which can provide the basis for the early diagnosis of HIE.