关键词: 神经丝蛋白, 核因子E2相关因子2, 新生儿窒息, 脑损伤

Abstract: Objective To analyze the association of the expression levels of serum neurofilament protein (NFP) and nuclear factor-erythroid 2-related factor-2 (Nrf2) in neonates with asphyxia, in order to provide theoretical reference for the diagnosis of early brain injury in neonatal asphyxia. Methods From May 2019 to April 2021, 91 full-term neonates with asphyxia admitted to Department of Neonatology, the Second Clinical Medical College of Yangtze University were selected as study subjects, and were divided into mild asphyxia group (n=40) and severe asphyxia group(n=51) according to Apgar score and umbilical artery blood gas analysis. Besides, neonates were divided into brain injury group (n=36) and non-brain injury group (n=55) according to the results of head MRI examination. Meanwhile, 50 full-term neonates without history of asphyxia and hypoxia, neurological disease and intrauterine infection, who were delivered in the Obstetrics Department of this hospital, were enrolled into the control group. Enzyme-linked immunosorbent (ELISA) method was used to detect serum NFP and Nrf2 expression levels. Pearson analysis was used to analyze the correlation of serum NFP and Nrf2 levels of the neonates in brain injury group with the score of Neonatal Behavioral Neurological Assessment (NBNA). ROC curve was used to analyze the diagnostic value of serum NFP and Nrf2 levels in the diagnosis of early brain injury in neonatal asphyxia. Results Serum NFP and Nrf2 levels of newborns in the mild asphyxia group and severe asphyxia group were significantly higher than those of the control group, and the NBNA score was significantly lower than that of the control group (F=294.939, 208.932, 286.915, P<0.001). Compared with newborns in the mild asphyxia group, serum NFP and Nrf2 levels of the newborns in the severe asphyxia group were significantly higher, and the NBNA score of the newborns was significantly lower (P<0.001). The levels of serum NFP and Nrf2 in neonates of the brain injury group were significantly higher than those of the non-brain injury group, and the NBNA score was significantly lower than that of the non-brain injury group (t=12.841, 12.539, 14.248, P<0.001). Pearson correlation analysis showed that serum NFP and Nrf2 levels of neonates in the brain injury group were negatively correlated with NBNA score (r＝-0.527,-0.401, P<0.001). The sensitivity and specificity of serum NFP combined with Nrf2 in the diagnosis of early brain injury in neonatal asphyxia was 94.44% and 81.82%, respectively, and the area under the curve was 0.925. Conclusions Serum NFP and Nrf2 levels in neonates with asphyxia are higher, which are associated with early brain injury of neonatal asphyxia. The combined detection of serum NFP and Nrf2 has a higher diagnostic value for the early brain injury of neonatal asphyxia.

Key words: neurofilament protein, nuclear factor-erythroid 2-related factor-2, neonatal asphyxia, brain injury