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目的探讨尿S100B蛋白、尿乳酸/肌酐比值对新生儿缺氧缺血性脑病(HIE)早期诊断的应用价值。方法检测58例足月HIE患儿在生后第1天、第2天、第3天,尿S100B蛋白、尿乳酸/肌酐比值水平,并在生后7天内进行HIE临床分度,以同期25例足月正常新生儿对照组。结果HIE组出生后3天内尿S100B蛋白含量和出生后1天内尿乳酸/肌酐比值明显高于对照组(P<0.001);3天内尿S100B蛋白和1天内尿乳酸/肌酐比值之间及与HIE的临床分度呈正相关(P<0.001);当尿S100B蛋白水平在0.47μg/L,尿乳酸/肌酐比值在0.55时,单独检测第3天尿S100B蛋白敏感度、特异度分别为90.4%、91.9%;尿乳酸/肌酐比值预测HIE的敏感度和特异度以出生后第1天最高,分别为91.5%和90.3%;如检测第3天尿S100B蛋白的同时监测生后1天内尿乳酸/肌酐比值可显著提高HIE诊断的准确性,联合应用两项指标进行检测,诊断的敏感度和特异度分别为98.8%、97.4%,较两种方法单独应用敏感度和特异度均提高。结论对窒息患儿以临床表现为基础,同时监测出生后3天内尿S100B蛋白和尿乳酸/肌酐比值,对提高HIE的早期诊断和临床分度具有一定的应用价值。
Objective To investigate the value of urinary S100B protein and urinary lactate / creatinine ratio in the early diagnosis of neonatal hypoxic-ischemic encephalopathy (HIE). Methods The urine S100B protein and urinary lactate / creatinine ratio were measured in 58 cases of full-term HIE children on day 1, day 2 and day 3 after birth. The HIE clinical sub-grade was performed within 7 days after birth. Cases of full-term normal newborn control group. Results The urine S100B protein level and the ratio of urinary lactate to creatinine within 1 day after birth in HIE group were significantly higher than those in control group (P <0.001) within 3 days after birth. The ratio of urinary S100B protein to urinary lactate to creatinine within 1 day and HIE (P0.001). When urine S100B protein level was 0.47μg / L and urinary lactate / creatinine ratio was 0.55, the sensitivity and specificity of urine S100B protein on day 3 alone were 90.4% and 90.4% 91.9%. The sensitivity and specificity of urinary lactate / creatinine ratio predicting HIE were 91.5% and 90.3% respectively on the first day after birth. For example, urinary S100B protein on the third day and urinary lactate / Creatinine ratio can significantly improve the accuracy of HIE diagnosis, the combination of two indicators for detection, the diagnostic sensitivity and specificity were 98.8%, 97.4%, compared with the two methods alone increased sensitivity and specificity. Conclusions Asphyxia patients with clinical manifestations based on the same time monitoring of 3 days after birth urinary S100B protein and urinary lactate / creatinine ratio, to improve the early diagnosis of HIE and clinical sub-index has a certain value.