目的 探讨血清Tau蛋白在早产儿脑损伤(BIPI)及其近期预后评估中的临床价值,为BIPI的防治提供参考依据。方法 连续性纳入2020年1—12月在唐山市妇幼保健院新生儿科住院的92例早产儿,按照矫正胎龄40周时的头颅B超及MRI诊断结果分为脑室周围-脑室内出血(PIVH)组(n=24)、脑室周围白质软化(PVL)组(n=10)及无脑损伤组(n=58)。比较三组的血清Tau蛋白及白细胞介素-6(IL-6)水平、振幅整合脑电图(aEEG)评分、中国20项新生儿行为神经测定(NBNA)评分,采用Pearson相关分析血清Tau蛋白水平与其他指标的相关性,采用ROC曲线分析各项指标的评估价值。结果 出生后1、3、7天,三组间血清Tau蛋白及IL-6水平比较,差异有统计学意义(F=18.227、20.273、18.569、16.375、17.283、18.144,P＜0.001),且PIVH组与PVL均显著高于无脑损伤组(P<0.05),PIVH组与PVL组间差异均无统计学意义(P＞0.05)。三组间出生后1周内aEEG评分、矫正胎龄40周时aEEG评分及NBNA评分比较,差异均有统计学意义(F=15.352、14.903、16.284,P＜0.001),且PIV组与PVL组均低于无脑损伤组(P<0.05),PIVH组与PVL组之间差异均无统计学意义(P＞0.05)。血清Tau蛋白水平与血清IL-6水平呈显著正相关(r=0.822,P＜0.05),与出生后1周内aEEG评分、矫正胎龄40周时aEEG评分及NBNA评分均呈显著负相关(r=-0.695、-0.647、-0.682,P＜0.05)。血清Tau蛋白评估BIPI的最佳阈值为183.39 pg/ml,AUC、敏感度及特异度分别为0.820、76.3%、85.2%,与出生后1周内aEEG评分、矫正胎龄40周时aEEG评分及NBNA评分比较,差异均无统计学意义(P＞0.05)。结论 血清Tau蛋白水平能够反映BIPI及其近期预后,当超过183.39 pg/ml时应当警惕BIPI的发生风险。

Objective To investigate the value of serum Tau protein in assessing brain injury in premature infants (BIPI) and the recent prognosis, so as to provide reference for the prevention and treatment of BIPI. Methods From January to December 2020, 92 premature infants hospitalized in the Neonatology Department of Tangshan Maternal and Child Health Care Hospital were consecutively included. According to the cranial B-ultrasound and MRI diagnosis results in corrected gestational age of 40 weeks, infants were divided into paraventricula-intraventricular hemorrhage(PIVH) group(n=24), periventricular leukomalacia(PVL) group(n=10) and non-brain injury group(n=58). Serum levels of Tau protein, interleukin-6(IL-6), amplitude electroencephalogram (aEEG) score and Neonatal Behavioral Neurological Assessment (NBNA) score were compared among the three groups. Results On the 1st, 3rd and 7th day after birth, serum levels of Tau protein and IL-6 were significantly different among PIVH group, PVL group and non-brain injury group (F=18.227, 20.273, 18.569, 16.375, 17.283, 18.144, P<0.01). Specifically, the levels of above indicators in PIVH group and PVL group were significantly higher than those in non-brain injury group (P<0.05), but the difference between PIVH group and PVL group was not significant (P>0.05). The aEEG scores within 1 week after birth, aEEG score and NBNA score at corrected gestational age of 40 weeks were significantly different among PIVH group, PVL group and non-brain injury group(F=15.352, 14.903, 16.284, P<0.05). In detail, the levels of above indicators in PIVH group and PVL group were significantly lower than those in non-brain injury group (P<0.05), but the difference between PIVH group and PVL group was not significant (P>0.05). Serum level of Tau protein was positively correlated with serum IL-6 level (r=0.822, P<0.05), and negatively correlated with aEEG score in the first week after birth, aEEG score and NBNA score at the corrected gestational age of 40 weeks (r=-0.695,-0.647,-0.682,P<0.05). The optimal threshold value of serum Tau protein in the assessment of BIPI was 183.39 pg/ml, and corresponding AUC, sensitivity and specificity was 0.820, 76.3% and 85.2%, respectively. There was no significant difference in the assessment value when predicting BIPI among serum Tau protein level, aEEG score in 1 week after birth, aEEG score and NBNA score at corrected gestational age of 40 weeks (P>0.05). Conclusions Serum level of Tau protein could reflect BIPI and the recent prognosis of infants. The occurrence of BIPI should be alerted when it exceeds 183.39 pg/ml.