足月儿高胆红素血症神经元特异性烯醇化酶、经皮小时胆红素、总胆红素/白蛋白水平变化及与远期神经发育的相关性

doi:10.11852/zgetbjzz2021-1637

摘要/Abstract

摘要： 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。

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

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.

Key words: full-term infants, hyperbilirubinemia, neuron-specific enolase, unconjugated bilirubin, total bilirubin, albumin, neurodevelopment

中图分类号:

R722.1

陈玉霞, 刘华艳, 范倩倩. 足月儿高胆红素血症神经元特异性烯醇化酶、经皮小时胆红素、总胆红素/白蛋白水平变化及与远期神经发育的相关性[J]. 中国儿童保健杂志, 2023, 31(1): 86-90.

CHEN Yu-xia, LIU Hua-yan, FAN Qian-qian. Changes of neuron specific enolase, transcutaneous hour bilirubin, total bilirubin/albumin levels in full-term infants with hyperbilirubinemia and their correlation with long-term neurodevelopment[J]. Chinese Journal of Child Health Care, 2023, 31(1): 86-90.

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