血浆少突胶质细胞髓鞘糖蛋白水平变化在诊断早产儿脑损伤中的价值

张军; 刘娟; 胡金绘; 武荣

doi:10.16766/j.cnki.issn.1674-4152.001733

血浆少突胶质细胞髓鞘糖蛋白水平变化在诊断早产儿脑损伤中的价值

doi: 10.16766/j.cnki.issn.1674-4152.001733

扬州大学附属淮安市妇幼保健院新生儿科，江苏淮安 223002

基金项目:

江苏省卫生健康委科研课题 H2018009

详细信息

通讯作者:
刘娟，E-mail：chilblain@163.com

中图分类号: R722.6 R446
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- 文章访问数: 111
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- 被引次数: 0
出版历程
- 收稿日期: 2020-06-25
- 网络出版日期: 2022-02-19

Changes in plasma odendmcyte-myelin glycoprotein levels for the diagnosis of brain injury in premature infants

Department of Paediatrics, Huai'an Maternity and Child Health Care Hospital, Yangzhou University, Huai'an, Jiangsu 223002, China

摘要

摘要: 目的通过测定神经元特异性烯醇化酶(neuron specific enolase，NSE)和少突胶质细胞髓鞘糖蛋白(odendmcyte-myelin glycoprotein，Omgp)水平，探讨其在早产儿脑损伤中的诊断价值。方法选取2019年1—12月在淮安市妇幼保健院新生儿医学中心住院治疗的80例早产儿，根据颅脑B超及MRI结果，按有无脑损伤分为脑损伤组(40例)及无脑损伤组(40例)。收集研究对象出生后6 h、72 h、7 d的血液标本，采用ELISA法测定NSE、Omgp水平，分析其对早产儿脑损伤的诊断价值。结果 (1) 脑损伤组生后6 h、72 h、7d NSE、Omgp水平较无脑损伤组显著升高。(2)早产儿脑损伤组生后6 h Omgp水平的ROC曲线下面积最大，为0.952，约登指数为0.813，灵敏度为87.50%，特异度为93.75%，对应的最佳阈值为57.971，阳性预测值97.22%，阴性预测值75.03%，高于NSE。(3)生后6 h、72 h、7 d Omgp水平与矫正胎龄40周NBNA评分负相关，相关系数分别为r=-0.728、-0.732、-0.752，均P＜0.01；生后6 h、72 h及7 d NSE与NBNA评分无明显相关性(均P＞0.05)。结论生后6 h NSE、Omgp水平可以作为BIPI的潜在诊断标志物，其中Omgp水平诊断准确率较高。生后6 h、72 h、7 d Omgp水平可能是预测BIPI预后的良好生物标志物。
- 早产儿 /
- 脑损伤 /
- 神经元特异性烯醇化酶 /
- 少突胶质细胞髓鞘糖蛋白
Abstract: Objective To investigate the relationship between brain injury and plasma odendmcyte-myelin glycoprotein (Omgp) levels and neuron-specific enolase (NSE) in premature infants, and analyze its clinical significance in premature infants with brain injury. Methods Total 80 cases of premature infants who were hospitalized in the Neonatal Medical Centre of Huai'an Maternal and Child Health Hospital from January 2019 to December 2019 were included in the study. According to the results of craniocerebral imaging, all infants were divided into brain injury group and non-brain injury group. Blood samples were obtained at 6, 72 and 168 h after birth. Levels of NSE and Omgp were detected via ELISA. The predictive value of plasma NSE and Omgp for brain injury in premature infants (BIPI) was analysed. Results (1) The NSE and Omgp levels in the brain injury group were significantly higher than that in the non-brain injury group at 6, 72 and 168 h after birth. (2)The area under ROC curve of OMgp level at 6 h after birth was the largest, which was 0.952, Yoden index was 0.813, sensitivity was 87.50%, specificity was 93.75%. The corresponding optimal threshold was 57.971, positive predictive value was 97.22%, and negative predictive value was 75.03%, which was higher than NSE. (3)The levels of Omgp at 6, 72 and 168 h were significantly negatively correlated with the NBNA score at 40 weeks of corrected gestational age (r=-0.728, -0.732 and -0.752, respectively; all P < 0.01). Levels of NSE had no significant correlation with prognosis at 6, 72 and 168 h after birth (all P>0.05) but could predict the prognosis. Conclusion Levels of NSE and Omgp at 6 h after birth are all correlated with BIPI and can be used as potential diagnostic markers. The diagnostic accuracy of Omgp level is higher. The Omgp levels at 6, 72 and 168 h after birth may be a good biomarker for predicting BIPI prognosis.
- Premature infant /
- Brain injury /
- Neuron-specific enolase /
- Odendmcyte-myelin glycoprotein

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图 1 生后6 h NSE、Omgp水平的ROC曲线

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表 1 2组早产儿一般资料比较(x±s)

组别	例数	性别 (男/女，例)	胎龄 (周)	分娩方式(阴道分娩/ 剖宫产，例)	出生体重 (g)	住院时间 (d)	胎膜早破 [例(%)]
脑损伤组	40	18/22	34.21±1.57	21/19	2 241.75±480.67	32.75±7.01	19(47.50)
无脑损伤组	40	17/23	34.72±2.03	25/15	2 206.50±594.09	30.13±5.92	20(50.00)
统计量		0.051^a	1.269^b	0.818^a	0.292^b	1.810^b	0.050^a
P值		0.822	0.208	0.366	0.771	0.074	0.823

组别	例数	产前感染 [例(%)]	妊娠期高血压 [例(%)]	羊水污染 [例(%)]	1 min Apgar评分 (分)	5 min Apgar评分 (分)	无创通气 [例(%)]	有创通气 [例(%)]
脑损伤组	40	27(67.50)	28(70.00)	23(57.50)	7.50±0.91	8.98±0.66	21(52.50)	12(30.00)
无脑损伤组	40	25(62.50)	27(67.50)	20(50.00)	7.68±0.86	9.00±0.60	27(67.50)	19(47.50)
统计量		0.220^a	0.058^a	0.453^a	0.887^b	0.177^b	1.875^a	2.581^a
P值		0.639	0.809	0.501	0.378	0.860	0.171	0.108
注：^a为χ²值，^b为t值。

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表 2 2组早产儿NSE水平比较(x±s，μg/L)

组别	例数	NSE水平
组别	例数	6 h	72 h	7 d
脑损伤组	40	13.35±2.13	13.08±2.30	11.21±1.90
无脑损伤组	40	9.73±1.91	9.73±1.75	9.12±1.89
t值		8.003	7.331	4.932
P值		＜0.001	＜0.001	＜0.001

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表 3 2组早产儿Omgp水平比较(x±s，ng/L)

组别	例数	6 h	72 h	7 d
脑损伤	40	68.03±10.02	74.50±11.32^a	73.12±11.54^ab
无脑损伤	40	48.70±4.63	49.18±5.42	49.40±4.62
t值		11.076	12.759	12.069
P值		＜0.001	＜0.001	＜0.001
注：与6 h组比较，^aP＜0.05；与72 h组比较，^bP＜0.05。

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表 4 新生儿血浆中NSE、Omgp对BIPI的预测价值

标志物	AUC (95% CI)	约登指数	截距	敏感性 (%)	特异性 (%)	阳性预测值(%)	阴性预测值(%)
NSE	0.895(0.784~0.961)	0.663	12.305	72.50	93.75	96.66	57.73
Omgp	0.952(0.859~0.991)	0.813	57.971	87.50	93.75	97.22	75.03

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表 5 新生儿脑损伤组NSE、Omgp水平与NBNA的相关性

项目	6 h		72 h		7 d
项目	r值	P值	r值	P值	r值	P值
NSE	0.005	0.975	-0.177	0.275	-0.159	0.326
Omgp	-0.728	< 0.001	-0.732	< 0.001	-0.752	< 0.001

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