关键词: 改良aEEG评分, 生化标记物, 高危新生儿, 脑损伤, 早期诊断

Abstract: Objective To explore the value of modified amplitude-integrated electroencephalography (aEEG) score combined with biochemical markers in the early diagnosis of high-risk neonatal brain injury, so as to provide evidence for its early diagnosis. Methods Data of 145 high-risk neonates treated in the Third Hospital of Xingtai from June 2017 to May 2019 were selected for retrospective analysis.The results of aEEG test of children were collected and assessed by modified aEEG score, Neonatal Critical Illness Score (NCIS) and biochemical marker test results of brain injury.Children were divided into two groups according whether with brain injury or not, and the modified aEEG score, NCIS score and biochemical markers of brain injury were compared between the two groups.The correlation between modified aEEG score, brain injury biochemical markers and NCIS score was analyzed.ROC method was used to analyze the value of modified aEEG score combined with biochemical markers in the early diagnosis of high-risk neonatal brain injury. Results Among the 145 children in this study, 79 were diagnosed with brain injury and 66 had no brain injury.There were no significant differences on gestational age, gender and delivery methods between the two groups (P>0.05).The birth weight and 1min Apgar score of children with brain injury were significantly lower than those of brain injury (t=-3.149,-8.401,P<0.05).The modified aEEG score, the levels of NSE and GFAP of brain injury group were significantly higher than those of non-brain injury group, and NCIS score and BDNF level of brain injury group were significantly lower than those of non-brain injury group(P<0.05).Correlation analysis results showed that the NCIS score was negatively related to modified aEEG score, NSE, GFAP levels(r=-0.618,-0.694,-0.583, P<0.05), while the level of BDNF was positively correlated with NCIS score (r=0.648, P<0.05).ROC analysis results showed the cut-off value of aEEG score for early diagnosis of high-risk neonatal brain injury was 9.18(AUC=0.902, 95%CI: 0.845-0.959).Similarly, the cut-off value of NSE was 15.04 μg/L (AUC=0.885, 95%CI: 0.821-0.949),the cut-off value of BDNF was 1.16 ng/ml(AUC=0.894, 95%CI: 0.834-0.954), and the cut-off value of GFAP was 4.61 ng/L(AUC=0.764, 95%CI: 0.666-0.862).And combined diagnosis can effectively improve the diagnostic sensitivity (sensitivity: 89.87%, specificity: 75.76%, P<0.05). Conclusions The modified aEEG score, NSE, BDNF and GFAP levels of high-risk neonates with brain injury can be significantly abnormal, which are significantly related to the severity of illness in children.AEEG score, NSE, BDNF and GFAP are all of high value in early diagnosis of high-risk neonates with brain injury, and the combination can improve the sensitivity of diagnosis.

Key words: modified aEEG score, biochemical markers, high-risk newborns, brain injury, early diagnosis