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

摘要： 目的 分析血清神经丝蛋白(NFP)、核因子E2相关因子2(Nrf2)水平与新生儿窒息早期脑损伤的关系,为新生儿窒息早期脑损伤的诊断提供理论依据。方法 选择2019年5月—2021年4月荆州市中心医院收治的窒息足月新生儿91例为观察对象,根据Apgar评分与脐动脉血气分析为轻度窒息组40例与重度窒息组51例,根据头颅MRI检查结果将其分为脑损伤组36例和非脑损伤组55例,另选取同期在本院产科分娩的正常足月新生儿(无窒息缺氧史、无神经系统疾病、无宫内感染)50例作为对照组。采用酶联免疫吸附(ELISA)法检测血清NFP、Nrf2水平,Pearson法分析脑损伤组新生儿血清NFP、Nrf2水平与新生儿行为神经测定(NBNA)评分的相关性,ROC曲线分析血清NFP、Nrf2对新生儿窒息早期脑损伤的诊断价值。结果 轻度窒息组与重度窒息组新生儿血清NFP、Nrf2水平显著高于对照组,NBNA评分显著低于对照组(F=294.939、208.932、286.915,P＜0.001),重度窒息组新生儿血清NFP、Nrf2水平显著高于轻度窒息组,NBNA评分显著低于轻度窒息组(P＜0.001);脑损伤组新生儿血清NFP、Nrf2水平显著高于非脑损伤组,NBNA评分显著低于非脑损伤组(t=12.841、12.539、14.248,P＜0.05);相关性分析结果显示,脑损伤组新生儿血清NFP、Nrf2水平与NBNA评分呈负相关性(r=-0.527、-0.401,P＜0.05);血清NFP、Nrf2联合诊断新生儿窒息早期脑损伤的敏感度为94.44%,特异度为81.82%,曲线下面积为0.925。结论 窒息新生儿血清NFP、Nrf2水平升高,与新生儿窒息早期脑损伤有一定相关性,且血清NFP、Nrf2联合检测对新生儿窒息早期脑损伤具有一定诊断价值。

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