Study on the value of modified amplitude-integrated electroencephalography score combined with biochemical markers in early diagnosis of high-risk neonatal brain injury

doi:10.11852/zgetbjzz2020-1035

Abstract

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

摘要： 目的探讨改良振幅整合脑电图(aEEG)评分联合生化标记物对高危新生儿脑损伤的早期诊断价值,以期为高危儿脑损伤的早期诊断提供参考依据。方法选择2017年6月-2019年5月在刑台市第三医院接受治疗的145例高危新生儿资料进行回顾性分析。收集患儿aEEG检测结果并以改良aEEG评分、新生儿危重病例评分(NCIS)及脑损伤生化标记物对结果进行评估。根据患儿有无脑损伤将其分为两组,比较两组患者改良aEEG评分、NCIS评分及脑损伤生化标记物。并对改良aEEG评分及脑损伤生化标记物与NCIS评分进行相关性分析,ROC法分析改良aEEG评分联合生化标记物对高危新生儿脑损伤的早期诊断价值。结果 145例患儿中79例诊断为脑损伤,66例无脑损伤。两组患儿胎龄、性别、分娩方式比较差异无统计学意义(P>0.05),脑损伤患儿出生体重及1 min Apgar评分均低于无脑损伤组(t=-3.149,-8.401,P<0.05)。脑损伤组患者改良aEEG评分、神经元特异性烯醇化酶(NSE)及血清胶质纤维酸性蛋白(GFAP)水平均显著高于无脑损伤组,脑损伤组NCIS评分及脑源性神经营养因子(BDNF)均显著低于无脑损伤组(P<0.05)。相关性分析结果显示,改良aEEG评分、NSE、GFAP与NCIS评分均呈显著负相关关系(r=-0.618,-0.694,-0.583, P<0.05),BDNF与NCIS评分均呈显著正相关关系(r＝0.648,P<0.05)。ROC分析结果显示改良aEEG评分对高危新生儿脑损伤早期诊断cut-off值为9.18分,AUC为0.902(95%CI:0.845~0.959);NSE cut-off值为15.04 μg/L,AUC为0.885(95%CI:0.821~0.949);BDNF cut-off值为1.16 ng/ml,AUC为0.894(95%CI:0.834~0.954);GFAP cut-off值为4.61 ng/L,AUC为0.764(95%CI:0.666~0.862),联合诊断可有效提高诊断敏感度(敏感度89.87%,特异度75.76%,P<0.05)。结论高危新生儿脑损伤者改良aEEG评分、NSE、BDNF及GFAP水平可出现明显异常,且上述指标均与患儿病情程度显著相关,aEEG评分、NSE、BDNF及GFAP均对高危新生儿脑损伤有较高的早期诊断价值,联合诊断可提高诊断的敏感度。

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

CLC Number:

R722.1

FENG Hui-min, JI Jing-lei, FENG Cai-li, FAN Xue-ai. Study on the value of modified amplitude-integrated electroencephalography score combined with biochemical markers in early diagnosis of high-risk neonatal brain injury[J]. journal1, 2020, 28(12): 1317-1321.

冯会敏, 冀京雷, 冯彩丽, 范雪爱. 改良振幅整合脑电图评分联合生化标记物对高危新生儿脑损伤早期诊断价值研究[J]. 中国儿童保健杂志, 2020, 28(12): 1317-1321.

References

[1] 张元铭,杨盛泉,艾莉莉.全身运动质量评估量表对早产脑损伤高危儿神经发育结局的预测价值[J].安徽医学,2019,40(3):241-244.
[2] Khairy MA, Abuelhamed WA, Ahmed RS, et al.Hearing loss among high-risk newborns admitted to a tertiary neonatal intensive care unit[J].J Matern Fetal Neonatal Med, 2018, 31(2):1756-1761.
[3] Owji ZP, Gilbert G, Saint-Martin C, et al.Brain temperature is increased during the first days of life in asphyxiated newborns: developing brain injury despite hypothermia treatment[J].Am J Neuroradiol, 2017, 38(11):2180-2186..
[4] Pironkova RP, Giamelli J, Seiden H, et al.Brain injury with systemic inflammation in newborns with congenital heart disease undergoing heart surgery[J].Exp Ther Med, 2017, 14(1):228-238.
[5] Wixey JA, Chand KK, Pham L, et al.Therapeutic potential to reduce brain injury in growth restricted newborns[J].J Physiol, 2018, 596(23):5675-5686.
[6] Vilan A, Ribeiro JM, Striano P, et al.A distinctive ictal amplitude-integrated electroencephalography pattern in newborns with neonatal epilepsy associated with KCNQ2 mutations[J].Neonatology, 2017, 112(4):387-393.
[7] 何柳, 夏斌, 虎春元, 等.新生儿危重病例评分法的临床应用[J].中华妇幼临床医学杂志:电子版,2017,13(2):162-168.
[8] 徐文慧.改良aEEG评分及两种危重症评分对高危儿脑损伤的早期诊断价值[D].南昌:南昌大学,2015.
[9] 刘敬,俞惠民,毛健,等.早产儿脑损伤诊断与防治专家共识[J].中国当代儿科杂志,2012,14(12):883-884.
[10] Jungner A, Vallius S, Bruschettini M, et al.Cardiopulmonary bypass in the newborn: effects of circulatory cell-free hemoglobin and hyperoxia evaluated in a novel rat pup model[J].Intensive Care Med Exp, 2017, 5(1):45-47.
[11] Julie AW, Kirat KC, Lily P, et al.Therapeutic potential to reduce brain injury in growth restricted newborns[J].J Physiology,2018,596(23):5675-5686.
[12] Balushi A, Vargas A, Stephanie BM, et al.Hypotension and brain injury in asphyxiated newborns treated with hypothermia[J].Am J Perinat,2018,35(1):31-38.
[13] Magalhães LVS.,Winckler MIB,Bragatti JA,et al.Early amplitude-integrated electroencephalogram as a predictor of brain injury in newborns with very low birth weight: a cohort study[J].J Child Neurol,2018,33(10):659-663.
[14] Koehler RC, Yang ZJ, Lee JK, et al.Perinatal hypoxic-ischemic brain injury in large animal models: relevance to human neonatal encephalopathy[J].J Cerebr Blood F Met,2018,38(12):2092-2111.
[15] Agut T, Roca P, García-Alix A.Neonatal status epilepticus undetected with single-channel aEEG[J].An Pediatr (Barc),2017,87(1):57-58.
[16] Eleonora B, Luigi G, Barbara P, et al.Epilepsy outcome in cooled hypoxic-ischemic encephalopathic newborns[J].J Pediat Epilepsy,2018,7(1):8-13.
[17] Peyvandi S, Synnes A, Poskitt K, et al.Neonatal brain injury and timing of neurodevelopmental assessment in patients with congenital heart disease[J].J Am Coll Cardiol,2018,71(18):1986-1996.
[18] Manon G, Enrico L, Sylke JS, et al.Persistent pulmonary hypertension of the newborn after fetomaternal hemorrhage[J].Transfusion,2018,58(12):2819-2824.
[19] Kushwah S, Kumar A, Verma A, et al.Comparison of fractional anisotropy and apparent diffusion coefficient among hypoxic ischemic encephalopathy stages 1, 2, and 3 and with nonasphyxiated newborns in 18 areas of brain[J].Indian J Radiol Imaging, 2017, 27(4):447-456.
[20] Zhang L, Wang L,Ning FB, et al.Erythropoietin reduces hippocampus injury in neonatal rats with hypoxic ischemic brain damage via targeting matrix metalloprotein-2[J].Eur Rev Med Pharmacol Sci, 2017, 21(19):4327-4333.