早产儿脑损伤与早期血清NSE水平及其影响因素分析

发布时间：2018-07-03 21:43

本文选题：早产儿脑损伤 + 神经元特异性烯醇化酶　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的本研究旨在以头颅MRI结果为标准,探讨早产儿脑损伤(brain injury in premature infants,BIPI)与生后24小时内血清神经元烯醇化酶(neuron specific enolase,NSE)水平的关系,及NSE对BIPI的预测价值;并分析影响BIPI患者生后24小时内血清NSE水平的因素,如胎龄、出生体重、分娩方式、单胎、多胎、Apgar评分、妊娠期高血压疾病(hypertensive disorders in pregnancy,HDP)、合并新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)等。为BIPI病情早期预测及评估提供临床依据。方法选取2016年1月至5月期间我院出生并住院的早产儿,均在生后24h内采血查血清NSE水平,同时完善常规化验及体格检查。均由统一培训合格的医护人员现场收集所有研究对象的基本信息及病例资料。结合临床症状、头颅MRI结果分为脑损伤组82例、非脑损伤组96例,对比两组血清NSE水平,并具体分析影响血清NSE水平的因素。结果(1)根据头颅MRI结果,比较两组生后24小时内早产儿血清NSE的检测结果,脑损伤组较无脑损伤组有所升高,差异有统计学意义(t=2.48,P㩳0.05)。(2)脑损伤组分娩方式、单胎与多胎间与血清NSE水平差异不明显,无统计学意义(P㧐0.05);(3)脑损伤组不同胎龄、出生体重间血清NSE水平差异有统计学意义(P㩳0.05)。(4)采用Pearson相关分析对脑损伤组胎龄、出生体重、母亲年龄进行相关性分析:胎龄与早产儿血清NSE水平存在良好的相关性,呈负相关,γ=-0.29,P=0.01;出生体重与早产儿血清NSE水平存在良好的相关性,呈负相关,γ=-0.47,P=0.00;母亲年龄与早产儿血清NSE水平无明显相关性,γ=0.07,P=0.98。(5)脑损伤组胎盘异常、脐带异常、羊水异常与血清NSE水平差异无统计学意义(P㧐0.05);HDP、胎膜早破、NSRD影响血清NSE水平(P㩳0.05)。(6)脑损伤组血清NSE的水平与胎龄、出生体重、胎膜早破、HDP、新生儿呼吸窘迫综合征存在线性回归关系,其中与出生体重呈负相关。由标准化系数看出生体重对血清NSE水平影响最大。结论1.BIPI生后24小时内血清NSE增高,说明生后早期检测NSE可以成为诊断BIPI的生物标志物。2.患儿的胎龄、出生体重、胎膜早破、HDP、NRDS为影响血清NSE水平的因素。3.早产儿的胎龄、出生体重、胎膜早破、HDP、NRDS与血清NSE水平存在线性回归关系,其中出生体重对血清NSE水平影响最大。
[Abstract]:Objective to investigate the relationship between (brain injury in premature infantile and serum neuron enolase (neuron specific Enolase) levels within 24 hours after birth, and to evaluate the predictive value of (brain injury in premature in preterm infants. The factors influencing serum NSE levels within 24 hours after birth were analyzed, such as gestational age, birth weight, mode of delivery, single fetus, multiple fetal Apgar score, (hypertensive disorders in presupposition of hypertensive disorder complicating pregnancy (hypertensive disorders in) and neonatal respiratory distress syndrome (neonatal respiratory distress syndromesia). To provide clinical basis for early prediction and evaluation of BIPI. Methods Serum NSE levels of premature infants born and hospitalized in our hospital from January to May 2016 were collected within 24 hours after birth, and routine laboratory tests and physical examination were completed at the same time. The basic information and case data of all the subjects were collected by trained qualified medical staff in the field. According to the clinical symptoms, the cranial MRI results were divided into brain injury group (n = 82) and non-brain injury group (n = 96). The serum NSE levels were compared between the two groups, and the factors affecting the serum NSE levels were analyzed. Results (1) according to the results of cranial MRI, the results of serum NSE in preterm infants within 24 hours after birth in the two groups were compared. The level of serum NSE in the brain injury group was higher than that in the non-brain injury group, and the difference was statistically significant (t = 2.48) P ~ (0.05). (_ 2) the delivery mode of the brain injury group was higher than that of the non-brain injury group. There was no significant difference in serum NSE levels between single and multiple births. There was no statistical significance (P0. 05); (3). There were significant differences in serum NSE levels between birth weight and brain injury group (P0. 05). (4). The gestational age and birth weight of brain injury group were analyzed by Pearson correlation analysis. There was a good correlation between gestational age and serum NSE level of premature infants, and there was a good correlation between birth weight and serum NSE level of premature infants, and there was a negative correlation between gestational age and serum NSE level of preterm infants, 纬 -0.29 P < 0.01, and a good correlation between birth weight and serum NSE level of premature infants. There was no significant correlation between maternal age and serum NSE level of premature infants. (5) placenta and umbilical cord were abnormal in brain injury group. There was no significant difference between amniotic fluid abnormalities and serum NSE levels (P0. 05). There was a linear regression relationship between serum NSE levels and fetal age, birth weight, premature rupture of membranes and neonatal respiratory distress syndrome in brain injury group. There was a negative correlation between birth weight and birth weight. The influence of birth weight on serum NSE level was the greatest in terms of standardized coefficient. Conclusion 1. Serum NSE increased within 24 hours after birth, indicating that early postnatal detection of NSE can be used as a biomarker for the diagnosis of BIPI. 2. Gestational age, birth weight and HDP- NRDS were the factors affecting serum NSE level. There was a linear regression relationship between fetal age, birth weight, premature rupture of membranes and serum NSE level, in which birth weight had the greatest influence on serum NSE level.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.6

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