目的 探讨足月儿高胆红素血症血清神经元特异性烯醇化酶(NSE)、经皮小时胆红素(hTcb)、总胆红素/白蛋白(B/A)水平变化及与远期神经发育相关性,为预测高胆红素血症患儿的远期神经发育提供理论依据。方法 选取2017年1月—2020年6月深圳市龙华区中心医院新生儿科足月高胆红素血症患儿240例为观察组,同期正常足月儿240例为对照组,比较两组一般资料、血清NSE、hTcb、B/A水平、观察组治疗前后血清NSE、hTcb、B/A水平,应用Logistic回归分析探讨血清各指标与高胆红素血症发病的关系,并对观察组患儿观察12个月,依据神经发育结局分为良好结局患儿(n＝214)、不良结局患儿(n＝26),统计不同神经发育结局患儿治疗前后血清NSE、hTcb、B/A水平,观察血清NSE、hTcb、B/A对患儿远期神经发育不良的预测价值。结果 治疗前,观察组血清NSE、hTcb、B/A水平高于对照组(t值分别为57.464、14.967、38.399,P<0.001),且观察组治疗后均低于治疗前(t值分别为46.855、43.201、32.847,P<0.001);经Logistic回归分析显示,血清NSE(OR=5.008,95%CI:3.263~7.685)、hTcb(OR=5.051,95%CI:3.028~8.426)、B/A(OR＝5.298,95%CI:2.856～9.829)均为足月儿高胆红素血症发病的重要影响因素(P＜0.05);观察组神经发育结局良好患儿治疗后血清NSE、hTcb、B/A水平均低于不良结局患儿(t值分别为28.441、5.190、17.499,P＜0.05);绘制受试者工作特征(ROC)曲线发现,血清NSE、hTcb、B/A联合预测远期神经发育不良的曲线下面积(AUC)均大于单一指标,联合预测的敏感度为88.46%,特异度为91.12%。结论 足月儿高胆红素血症患儿血清NSE、hTcb、B/A水平异常升高,且三者联合检测可为远期神经发育预测提供一定依据。
Abstract
Objective To investigate the changes of serum neuron specific enolase(NSE), transcutaneous hour bilirubin(hTcb) and total bilirubin/albumin(B/A) in full-term infants with hyperbilirubinemia and their correlation with long-term neurodevelopment, in order to provide reference for predicting the long-term outcome of neurodevelopment of full-term infants. Methods A total of 240 full-term newborns with hyperbilirubinemia in the Department of Pediatrics, Longhua District Central Hospital of Shenzhen City from January 2017 to June 2020 were selected into the observation group, meanwhile 240 healthy full-term infants were selected into the control group. The general data, serum levels of NSE, hTcb and B/A, and serum levels of NSE, hTcb and B/A in the observation group before and after treatment were compared. Logistic regression analysis was used to explore the relationship between serum indices and the incidence of hyperbilirubinemia. Children in the observation group were observed for 12 months, then were divided into good outcome group(n=214) and poor outcome group(n=26). Serum levels of NSE, hTcb and B/A of children in good outcome group and poor outcome group were tested before and after treatment, and the predictive value of serum NSE, hTcb and B/A in long-term neurodysplasia was observed. Results Serum levels of NSE, hTcb and B/A in the observation groupwere higher than those in the control group (t=57.464,14.967,38.399,P<0.001),and those in the observation group after treatment were lower than those before treatment(t=46.855,43.201,32.847,P<0.001). Logistic regression analysis showed that serum levels of NSE(OR=5.008,95%CI:3.263 - 7.685), hTcb(OR=5.051,95%CI:3.028 - 8.426)and B/A(OR=5.298,95%CI:2.856 - 9.829)were all important factors affecting the pathogenesis of hyperbilirubinemia in full-term infants(P＜0.05). After treatment, serum levels of NSE, hTcb and BCMA in the observation group with good neurodevelopmental outcome were lower than those with poor outcome(t=28.441,5.190,17.499, P＜0.05). The area under the curve(AUC) of the combined serum NSE, hTcb and B/A to predict long-term neurodevelopment was greater than that of the single indicator, the sensitivity and specificity of combined prediction were 88.46% and 91.12%, respectively. Conclusion The serum levels of NSE, hTcb and B/A in full-term infants with hyperbilirubinemia are abnormally increased, and the combined detection of the above three indicators can provide basis for the prediction of long-term neurodevelopment.
关键词
足月儿 /
高胆红素血症 /
神经元特异性烯醇化酶 /
非结合胆红素 /
总胆红素 /
白蛋白 /
神经发育
Key words
full-term infants /
hyperbilirubinemia /
neuron-specific enolase /
unconjugated bilirubin /
total bilirubin /
albumin /
neurodevelopment
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参考文献
[1] Kato S,Iwata O,Yamada Y,et al.Standardization of phototherapy for neonatal hyperbilirubinemia using multiple-wavelength irradiance integration[J].Pediatr Neonatol,2020,61(1):100-105.
[2] 曾超军,林少莲,林昶.新生儿高胆红素血症对婴幼儿期听力及学龄前发育的影响[J].中华耳科学杂志,2020,18(1):68-73.
Zeng CJ, Lin SL, Lin C.Effect of neonatal hyperbilirubinemia on hearing and preschool development in infants[J].Chin J Otology, 2020,18 (1):68-73.
[3] Yan K,Xiao F,Jiang Y,et al.Amplitude of low-frequency fluctuation may be an early predictor of delayed motor development due to neonatal hyperbilirubinemia:A fMRI study[J].Transl Pediatr,2021,10(5):1271-1284.
[4] 阳华妹,邓毅,王丽,等.高胆红素血症足月新生儿血清NSE、脐血白蛋白水平对脑损伤的预测价值[J].海南医学院学报,2020,26(19):1480-1484.
Yang HM, Deng Y, Wang L, et al.Predictive value of serum NSE and cord blood albumin levels in full-term neonates with hyperbilirubinemia on brain injury[J].J Hainan Medical College, 2020, 26 (19):1480-1484.
[5] Amin SB,Smith T,Timler G.Developmental influence of unconjugated hyperbilirubinemia and neurobehavioral disorders[J].Pediatr Res,2019,85(2):191-197.
[6] 代红,范小康.高胆红素血症新生儿血清NPY,S100B蛋白,B/A比值与胆红素脑损伤的关系[J].海南医学,2020,31(23):64-67.
Dai H, Fan XK.The relationship between serum NPY, S100B protein, B/A ratio and bilirubin brain injury in neonates with hyperbilirubinemia[J].Hainan Med J, 2020, 31 (23):64-67.
[7] 中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿高胆红素血症诊断和治疗专家共识[J].中华儿科杂志,2014,52(10):745-748.
Neonatology Group of Pediatric Branch of Chinese Medical Association, Editorial Committee of Chinese Journal of Pediatrics.Expert consensus on diagnosis and treatment of neonatal hyperbilirubinemia[J]. Chin J Pediatr,2014,52(10):745-774.
[8] 杨瑶,谭惠月,于新桥.早期振幅整合脑电图对重度高胆红素血症新生儿神经发育结局的预测[J].中国儿童保健杂志,2020,28(11):1267-1270.
Yang Y,Tan HY,Yu XQ.Prediction of neurodevelopmental outcome of neonates with severe hyperbilirubinemia by early amplitude integrated electroencephalography[J]. Chin J Child Health Care, 2020, 28 (11):1267-1270.
[9] Huang J,Zhao Q,Li J,et al.Correlation between neonatal hyperbilirubinemia and vitamin D levels:A meta-analysis[J].PLoS One,2021,16(5):e0251584.
[10] Nam GS,Kwak SH,Bae SH,et al.Hyperbilirubinemia and follow-up auditory brainstem responses in Preterm infants[J].Clin Exp Otorhinolaryngol,2019,12(2):163-168.
[11] 陈清,钱霜霜,林锋.NSE联合NPY对新生儿高胆红素血症脑损伤早期诊断的临床意义[J].重庆医学,2019,48(10):1784-1786.
Chen Q,Qian SS, Lin F.Clinical significance of NSE combined with NPY in early diagnosis of neonatal hyperbilirubinemia brain injury[J]. Chongqing Med J, 2019, 48 (10):1784-1786.
[12] 张昊,李久伟.血清NSE联合颅脑MRI在预测新生儿高胆红素血症脑损伤中的应用价值[J].川北医学院学报,2019,34(3):415-418.
Zhang H, Li JW.The value of serum NSE combined with brain MRI in predicting neonatal hyperbilirubinemia brain injury[J]. J North Sichuan Med College, 2019, 34 (3):415-418.
[13] Cui X,Zhou B,Wu J,et al.Changes in amplitude-integrated electroencephalography,neuron-specific enolase,and S100B in neonates with brain injury induced by neonatal hyperbilirubinemia and their significance[J].Brain Inj,2021,35(8):943-948.
[14] 刘兆敏,李丽,向垚林,等.高胆红素血症新生儿脑脊液NSE及胆红素水平变化与远期神经发育的关系[J].热带医学杂志,2019,19(6):747-750.
Liu ZM, Li L, Xiang YL, et al.The relationship between the changes of NSE and bilirubin levels in cerebrospinal fluid and long-term neurodevelopment in neonates with hyperbilirubinemia[J]. J Trop Med, 2019, 19 (6):747-750.
[15] Cayabyab R,Ramanathan R.High unbound bilirubin for age:A neurotoxin with major effects on the developing brain[J].Pediatr Res,2019,85(2):183-190.
[16] 阳华妹,邓毅,唐正荣,等.足月新生儿小时胆红素百分位值与黄疸诊疗的研究[J].热带医学杂志,2019,19(8):102-105.
Yang HM, Deng Y, Tang ZG, etal.Study on hourly bilirubin percentile value and diagnosis and treatment of jaundice in term neonates[J]. J Trop Med, 2019, 19 (8):102-105.
[17] 梁文英.新生儿重度高胆红素血症B/A比值与听性脑干诱发电位异常的关系[J].现代医药卫生,2019,35(9):1397-1399.
Liang WY.The relationship between B/A ratio and abnormal auditory brainstem evoked potentials in neonates with severe hyperbilirubinemia[J].Modern Med Heal, 2019, 35 (9):1397-1399
[18] 高淑强,悦光,杜逸婷.高胆红素血症新生儿血清NSE、B/A比值水平与胆红素脑损伤的关系[J].解放军预防医学杂志,2018,36(7):896-898,917.
Gao SQ, Yue G, Du YT.The relationship between serum NSE, B/A ratio and bilirubin brain injury in neonates with hyperbilirubinemia[J].J Prevent Med PLA, 2018, 36 (7):896-898,917.
基金
深圳龙华区医疗卫生机构区级科研项目(2020178)
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