目的 分析神经元特异性烯醇化酶(NSE)、振幅整合脑电图(aEEG)及视频脑电图(VEEG)在不同血糖水平足月儿的变化趋势及特点,为辅助评估不同血糖水平下患儿脑损伤及脑功能变化提供临床依据。方法 选取2019年1-8月淮坊医学院附属医院新生儿科收治的83例入院血糖低于＜2.8 mmol/L的足月儿为研究对象,按住院后最低血糖水平分为轻度低血糖组39例(2.2 mmol/L≤血糖＜2.8 mmol/L),中度低血糖组31例(1.1 mmol/L≤血糖＜2.2 mmol/L),重度低血糖组13例(血糖＜1.1 mmol/L);选取同时期入院血糖正常,但存在高危因素的新生儿40例作为对照组。入院后低血糖患儿均每3 h检测1次血糖,连续2次检测血糖均在正常范围后行aEEG检测6 h,对照组在入院后72 h内检测aEEG。所有患儿完成aEEG后12 h内检测VEEG;入院1 d、3 d、5 d检测血清NSE。对aEEG及VEEG采用秩和检验,NSE变化采用t检验,组间比较采用F检验。结果 1)各组新生儿母亲妊娠期血糖升高比例差异有统计学意义(P=0.03)。2)低血糖组患儿的NSE均明显升高;不同血糖水平足月儿的NSE水平比较,差异有统计学意义(F=965.759,P＜0.001),时间与血糖值对NSE水平的影响存在交互作用(F=31.14,P＜0.001)。3)轻、中、重度低血糖组aEEG周期性评分及总分差异有统计学意义(H=25.192、17.824,P＜0.01),重度低血糖组的总分、周期性、带宽与下边界振幅低于对照组,其总分和周期性低于轻度低血糖组,差异有统计学意义(U_重-对=113.0、111.5、188.0;U_重-轻=132.5、110.5,P＜0.05);中度低血糖组的总分及周期性评分低于对照组及轻度低血糖组,差异有统计学意义(U_中-对=366.0、348.5;U_中-轻=420.5、344.5,P＜0.05)。4)各组患儿视频脑电图均无异常。结论 不同血糖水平下NSE存在差异性,可作为辅助临床医师评估单纯低血糖患儿脑损伤的可能性及程度的指标之一;中重度低血糖可导致新生儿aEEG改变,以周期性改变为主,VEEG不敏感。

Objective To analyze the change trend and characteristics of neuron specific enolase (NSE), amplitude integrated electroencephalograghy (aEEG) and video electroencephalogram (VEEG) in term infants, in order to provide clinical reference for assessing brain injury and brain function changes in term infants with different blood glucose levels. Methods A total of 83 full-term neonates diagnosed with neonatal hypoglycemia were selected from the Affiliated Hospital of Weifang Medical College from January to August 2019.According to the minimum blood glucose level, the objects were divided into mild hypoglycemia group (39 cases)(2.2 mmol/L≤blood glucose＜2.8 mmol/L), moderate hypoglycemia group(31 cases) (1.1 mmol/L≤blood glucose＜2.2 mmol/L) and severe hypoglycemia group(13 cases) (blood glucose＜1.1 mmol/L).Meanwhile, 40 neonates with normal blood glucose with high risk factors were selected as control group.Children with hypoglycemia were tested every 3 hour.aEEG was performed 6 hours after that two consecutive blood glucose tests were in normal range.Newborns in control group were given 6 hours of aEEG in 72 hours.VEEG was detected in both groups within 12 hours after aEEG.Serum NSE levels were measured on the 1st, 3rd and 5th day.Rank sum test was used for aEEG and VEEG, t test was used for the change of NSE, and F test was used for intergroup comparisons. Results 1) The incidence of pregnancy-induced maternal blood glucose elevation was statistically significant among each group (P=0.03).2) The level of NSE in neonates with hypoglycemia was higher.There were significant differences on NSE level among children with different blood glucose levels (F=965.759, P<0.001), and there was an interaction effect on NSE level between time and blood glucose values (F=31.14,P＜0.001).3)There were significant differences on sleep-wake cycle(SWC) and total score of aEEG among mild, moderate and severe hypoglycemia groups (H=25.192,17.824, P＜0.01).The total score, SWC and bandwidth in severe hypoglycemia group were significantly lower than those of control group(U=113.0, 111.5, 188.0), and the total score and SWC were lower than those in mild hypoglycemia group (U=132.5, 110.5,P＜0.05).The total score and presence of cyclic changes in electrical activity of moderate hypoglycemia group were significantly lower than those of control group (U=366.0, 348.5)and mild hypoglycemia group (U =420.5, 344.5, P＜0.05).4) VEEG result was normal in all groups. Conclusions NSE level is different in children with different blood glucose levels, which can be used as an index to evaluate the possibility and degree of brain injury in children with simple hypoglycemia.Moderate and severe hypoglycemia can lead to changes in neonatal aEEG, mainly in SWC changes.However, VEEG can not be a sensitive index for hypoglycemia.