脐带血血清肌钙蛋白I、肌红蛋白、CK-MB与新生儿缺氧缺血性脑病的相关性研究

发布时间：2018-04-09 07:53

本文选题：新生儿缺氧缺血性脑病　切入点：心肌肌钙蛋白I　出处：《青岛大学》2017年硕士论文

【摘要】：目的通过联合检测新生儿脐带血血清肌钙蛋白I(cardiac troponin I,cTnI)、肌红蛋白(myoglobin,Mb)、心肌型肌酸激酶同工酶(MB fraction of creatine kinase,CK-MB)在新生儿缺氧缺血性脑病(hypoxic ischemic encephalo-pathy,HIE)水平变化,探讨其在新生儿HIE中的临床应用价值。方法2016年01月~2016年12月间在金乡人民医院产科分娩,具有围产期窒息高危因素,可能发生HIE的60例足月单胎新生儿作为观察组,同时选取足月无围产期窒息高危因素的健康单胎新生儿20例作为对照组。随诊发现观察组中患新生儿HIE的54例,设为HIE组,其中轻中重组分别有10、36、8例。未患HIE的设为非HIE组,共6例。新生儿娩出后立即抽取脐静脉血4ml。采用化学发光法检测血清cTnI、Mb,免疫抑制法检测CK-MB水平,分析不同指标预测HIE及其心肌损伤的临床价值。结果各组新生儿性别、胎龄、体重、身长、分娩方式无差异(P0.05)。HIE组心血管表现、心电图及心脏超声异常的发生率明显高于非HIE组及对照组(P0.05)。中重度HIE组脐带血血清cTnI、Mb水平明显高于轻度组、非HIE组和对照组(P0.05),轻度组与非HIE组、对照组比较差异无统计学意义。中重度HIE组脐带血血清CK-MB水平明显高于轻度组、非HIE组和对照组(P0.05),轻度HIE组CK-MB水平明显高于非HIE组和对照组(P0.05)。脐带血血清cTnI、Mb和CK-MB三个指标之间及三个指标与HIE组病情严重程度呈正相关(相关系数均0且P值均0.05)。脐带血血清cTnI、Mb、CK-MB诊断HIE的ROC曲线下面积分别为0.896、0.932、0.925,最佳诊断界点分别为0.0157ng/ml、96.53 ng/ml、43.0U/L。脐带血血清cTnI、Mb、CK-MB和联合诊断模型PRE之间AUC两两比较,cTnI、Mb、CK-MB三者之间无统计学意义(P0.05),cTnI、Mb、CK-MB三者分别与PRE比较有统计学意义(P0.05)。脐带血血清cTnI、Mb、CK-MB诊断HIE心肌损伤的ROC曲线下面积分别为0.767、0.679、0.798,最佳诊断界点分别为0.0159ng/ml、161.47 ng/ml、81.48U/L。cTnI、Mb、CK-MB和联合诊断模型PRE之间AUC两两比较,cTnI、Mb、CK-MB之间无统计学意义(P0.05),cTnI、CK-MB与PRE无统计学意义(P0.05),Mb与PRE比较差异有统计学意义(P0.05)。结论HIE组新生儿脐带血血清cTnI、Mb、CK-MB水平有不同程度的升高,脐带血血清cTnI、Mb、CK-MB水平可早期反映HIE病情严重程度;早期联合检测脐带血血清cTnI、Mb、CK-MB可早期预测HIE的发生、有效评估其严重程度,为早期干预、改善预后提供理论依据;早期检测脐带血血清cTnI、CK-MB可以早期预测HIE心肌损伤的发生。
[Abstract]:Objective to detect the changes of serum I(cardiac troponin troponin cTnI, myoglobin myoglobin MbP, myocardial creatine kinase isoenzyme MB fraction of creatine kinases CK-MBs in neonates with hypoxic ischemic encephalopathy (HIE) by means of combined detection of the levels of I(cardiac troponin IcTnI, myoglobin myoglobinine (MB) and myocardial creatine kinase isoenzyme (MB fraction of creatine kinases) in neonates with hypoxic-ischemic encephalopathy (HIE).To explore the clinical application value of HIE in neonates.Methods from January 2016 to December 2016, 60 neonates with term single fetus who had perinatal asphyxia risk factors in Jinxiang people's Hospital were used as observation group.At the same time, 20 healthy singleton neonates without perinatal asphyxia risk factors were selected as control group.54 cases of neonatal HIE in the observation group were divided into HIE group, including 1036 cases of mild moderate recombination.The patients without HIE were divided into non-HIE group (n = 6).Umbilical vein blood was extracted immediately after delivery.Serum cTnI Mb was detected by chemiluminescence assay and CK-MB level was detected by immunosuppressive method. The clinical value of different indexes in predicting HIE and myocardial injury was analyzed.Results there was no significant difference in sex, gestational age, body weight, body length and delivery pattern between the groups. The incidence of abnormal ECG and echocardiography in the group of HIE was significantly higher than that in the group without HIE and the control group (P 0.05).The level of cTnI Mb in cord blood of moderate and severe HIE group was significantly higher than that of mild group, non-#en1# group and control group (P0.05). There was no significant difference between mild group and non-#en2# group.The level of serum CK-MB in moderate and severe HIE group was significantly higher than that in mild group. The level of CK-MB in mild HIE group was significantly higher than that in non-#en5# group and control group (P0.05).Serum cTnIb and CK-MB were positively correlated with the severity of HIE (correlation coefficient 0 and P = 0.05).The area under the ROC curve of cord blood serum cTnI MbCK-MB for the diagnosis of HIE was 0.8960.932 卤0.925, and the best diagnostic threshold was 0.0157ng / ml 96.53ng / ml ~ (43.0) U / L, respectively.Comparison of AUC between CK-MB in cord blood serum cTnI and AUC in combined diagnostic model MbCK-MB there was no significant difference among CK-MB and CK-MB of cTnInCK-MB. There was significant difference between CK-MB of cTnI and MbCK-MB compared with that of PRE (P 0.05).The difference of PRE was statistically significant (P 0.05).Conclusion the level of CK-MB in umbilical cord blood of neonates in HIE group is increased in varying degrees, and the level of CK-MB in cord blood can reflect the severity of HIE at an early stage, and the early detection of CT-MB in cord blood can predict the occurrence of HIE and evaluate its severity.Early detection of serum cTnIK-MB in umbilical cord blood can early predict the occurrence of myocardial injury in HIE.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742

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