NSE对预测新生儿高胆红素血症脑损伤的价值进行系统评价

发布时间：2018-12-11 10:53

【摘要】：目的:新生儿高胆红素血症是新生儿时期的一种常见疾病。新生儿高胆红素血症会损害患儿多个器官,特别是血清游离胆红素可引起脑损伤。胆红素脑病是引起儿童智力发育落后、听力减弱的一个非常重要的原因。急性胆红素脑病的早期的临床表现常常缺乏特异性,对于胆红素脑病的诊断则多依赖于其临床表现。本文旨在研究神经元特异性烯醇化酶(NSE)对预测新生儿高胆红素血症脑损伤的价值进行系统评价,为胆红素脑病的尽早发现及治疗提供依据。方法:计算机检索CBM、万方数据库、中国知网、MEDLINE、PUBMED和Embase,检索从建库至2016年9月止关于NSE与高胆红素血症关系的随机对照研究。追踪检索文献的参考文献,以尽量降低漏检率。文献的筛选、资料的提取以及对纳入的实验进行质量评价,并使用Rev Man 5.1进行Meta分析。结果:共纳入研究文献22篇,其中仅1篇文献研究脑脊液神经元特异性烯醇化酶与胆红素关系。Meta分析结果显示:1血清胆红素水平与NSE含量关系的研究:早产儿实验组NSE含量高于正常对照组,差异有统计学意义(MD 22.29,95%CI 0.23~24.35);足月儿不同胆红素水平各亚组间实验组NSE含量高于对照组,差异有统计学意义。2 NSE在评估新生儿高胆红素血症脑损伤价值方面的研究:BAEP异常组NSE含量高于BAEP正常组,差异有统计学意义(MD 50.64,95%CI 36.35~64.94);NBNA异常组血清、脑脊液NSE含量高于NBNA正常组;颅脑MRI异常组NSE含量高于颅脑核磁正常组,差异有统计学意义(MD107.31,95%CI 99.25~115.36)。结论:血清、脑脊液中NSE含量可以作为敏感指标对胆红素脑损伤即胆红素脑病进行判断,在胆红素对中枢神经系统毒性的早期发现且给予积极地干预方面有着重要的意义。但目前的研究均未提及新生儿期血清、脑脊液NSE含量的正常值范围,纳入各研究均与对照组NSE含量进行比较,因此关于新生儿血清NSE含量正常值范围有待进一步研究。
[Abstract]:Objective: neonatal hyperbilirubinemia is a common disease in neonatal stage. Neonatal hyperbilirubinemia can damage multiple organs, especially serum free bilirubin, which can cause brain damage. Bilirubin encephalopathy is a very important cause of mental retardation and impaired hearing in children. The early clinical manifestations of acute bilirubin encephalopathy often lack specificity, and the diagnosis of bilirubin encephalopathy depends on its clinical manifestations. The purpose of this study was to evaluate the value of neuron-specific enolase (NSE) in the prediction of neonatal hyperbilirubinemia brain injury, and to provide evidence for early detection and treatment of bilirubin encephalopathy. Methods: a randomized controlled study on the relationship between NSE and hyperbilirubinemia was conducted from the establishment of the CBM, Wanfang database, the Chinese information network, MEDLINE,PUBMED and Embase, from the establishment of the database to September 2016. Track the references of the retrieval documents to reduce the missed detection rate as far as possible. Literature screening, data extraction and quality evaluation of the included experiments were performed, and Meta analysis was performed using Rev Man 5.1. Results: a total of 22 articles were included in the study. Meta analysis showed that: (1) the relationship between serum bilirubin and serum bilirubin level: the NSE content in the experimental group was higher than that in the normal control group. The difference was statistically significant (MD 22.2995 CI 0.23 ~ 24.35); The content of NSE in the experimental group with different bilirubin levels in term infants was higher than that in the control group, and the difference was statistically significant. 2 the value of NSE in evaluating the brain injury of neonatal hyperbilirubinemia: the NSE content in the abnormal BAEP group was higher than that in the normal group of BAEP. The difference was statistically significant (MD 50.6495 CI 36.35 64.94); The content of NSE in serum and cerebrospinal fluid in abnormal NBNA group was higher than that in normal NBNA group, and the content of NSE in abnormal MRI group was higher than that in normal brain nuclear magnetic field group (MD107.31,95%CI 99.25, 115.36). Conclusion: the content of NSE in serum and cerebrospinal fluid can be used as a sensitive index to judge bilirubin brain injury, I. E. bilirubin encephalopathy, which has important significance in early detection of bilirubin toxicity to central nervous system and active intervention. However, none of the current studies mentioned the normal range of NSE content in serum and cerebrospinal fluid (CSF). All the studies were compared with the NSE content in the control group. Therefore, the normal range of serum NSE content in neonates needs to be further studied.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1

【参考文献】