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目的探讨S-100B蛋白水平动态变化对早期诊断新生儿缺氧缺血性脑病(HIE)的价值。方法选择2009年5月至2011年5月我院新生儿重症监护病房收治的窒息新生儿为病例组,同期随机选取我院出生的40例健康新生儿为对照组,分别于生后6 h内、(72±6)h取血检测血清S-100B蛋白水平,并与7天内最终确诊HIE的程度进行对照分析。结果轻度窒息组和重度窒息组生后6 h内血清S-100B蛋白水平均高于对照组[(0.40±0.24)μg/L、(0.89±0.34)μg/L比(0.28±0.14)μg/L],重度窒息组高于轻度窒息组,P均<0.01。生后72 h,轻度窒息组已恢复至对照组水平(P>0.05),重度窒息组仍高于轻度窒息组[(0.44±0.21)μg/L比(0.26±0.10)μg/L,P<0.01]。窒息合并颅内出血患儿生后6 h内、72 h血清S-100B蛋白水平均高于重度窒息组[(2.61±1.08)μg/L比(0.89±0.34)μg/L,(1.64±0.71)μg/L比(0.44±0.21)μg/L,P<0.01]。生后6 h内血清S-100B蛋白水平诊断HIE的敏感度及阴性预测值分别为97.4%、97.7%,但特异度及阳性预测值较低。生后72 h血清S-100B蛋白水平诊断HIE的特异度及阳性预测值均为100%,但敏感度及阴性预测值较低。故以6 h内血清S-100B蛋白水平作为HIE初筛指标可以减少漏诊,结合72 h血清S-100B蛋白水平可以提高中重度HIE的诊断特异度。结论动态监测新生儿窒息后72 h内血清S-100B蛋白水平可作为早期评价脑损伤的敏感指标,为HIE的早期诊断及干预治疗提供客观依据。
Objective To investigate the value of dynamic changes of S-100B protein in the early diagnosis of neonatal hypoxic-ischemic encephalopathy (HIE). Methods From May 2009 to May 2011, neonatal asphyxia neonates admitted to neonatal intensive care unit in our hospital were selected as the case group. Forty healthy newborns born in our hospital were randomly selected as the control group during the 6 hours after birth , (72 ± 6) h blood to detect the serum S-100B protein level, and with the final diagnosis of HIE within 7 days the extent of controlled analysis. Results The levels of serum S-100B protein in 6 hours after birth in mild asphyxia group and severe asphyxia group were significantly higher than those in control group (0.40 ± 0.24μg / L, 0.89 ± 0.34μg / L, 0.28 ± 0.14μg / L, / L], severe asphyxia group than mild asphyxia group, P <0.01. At 72 h after birth, mild asphyxia group was recovered to the control group (P> 0.05), severe asphyxia group was still higher than that of mild asphyxia group (0.44 ± 0.21) μg / L (0.26 ± 0.10) μg / L, P <0.01]. The level of serum S-100B protein at 72 h after asphyxia in children with intracranial hemorrhage was significantly higher than that in severe asphyxia group (2.61 ± 1.08) μg / L (0.89 ± 0.34) μg / L and (1.64 ± 0.71) μg / L ratio (0.44 ± 0.21) μg / L, P <0.01]. The sensitivity and negative predictive value of serum S-100B protein level in diagnosis of HIE within 6 h after birth were 97.4% and 97.7%, respectively, but the specificity and positive predictive value were lower. The specificity and positive predictive value of serum S-100B protein level at 72 h after birth were 100%, but the sensitivity and negative predictive value were lower. Therefore, serum S-100B protein level within 6 h as a HIE screening index can reduce missed diagnosis, combined with 72 h serum S-100B protein levels can improve the diagnosis of moderate-severe HIE specificity. Conclusion The dynamic monitoring of serum S-100B protein levels within 72 hours after neonatal asphyxia can be used as a sensitive indicator for early assessment of brain injury, providing an objective basis for the early diagnosis and intervention of HIE.