脐带血血清NT-proBNP和心肌酶检测对新生儿缺氧缺血性脑病的临床价值

发布时间：2018-05-17 03:39

本文选题：缺氧缺血性脑病 + N末端B型钠尿肽原　；参考：《青岛大学》2017年硕士论文

【摘要】：目的探讨脐带血血清N末端B型钠尿肽原(NT-pro BNP)及心肌酶在新生儿缺氧缺血性脑病(HIE)中的变化,评估其对新生儿HIE临床诊断的预测价值。方法选取足月、无围产期窒息高危因素和生后窒息史的健康新生儿20例作为对照组;将胎龄为(37-42)周,有围产期窒息高危因素的60例新生儿作为观察组,根据是否发生HIE及HIE的病情分度分为非HIE组(6例)、轻度HIE组(10例)、中度HIE组(36例)和重度HIE组(8例)。分别观察两组新生儿的临床资料、心电图、心脏超声的结果;于分娩后立即抽取脐静脉血4ml,分别检测脐带血清NT-pro BNP、心肌酶水平,计算脐带血血清NT-pro BNP和心肌酶诊断HIE的诊断价值。结果两组患儿性别、胎龄、体重、身长、分娩方式差别无统计学意义(P0.05)。具有窒息高危因素的观察组HIE发生率高于对照组,差异有统计学意义(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,且差异有统计学意义(P0.05)。观察组血清NT-pro BNP水平明显高于对照组(P0.05)。HIE组心肌酶(CK-MB、CK、LDH、AST)水平明显高于非HIE组及对照组(P0.05),非HIE组及对照组CK-MB结果无明显差异(P0.05)。HIE组血清NT-pro BNP与CK-MB水平呈正相关(r=0.537,P0.05),二者水平与HIE组病情严重程度呈正相关(r1=0.608,r2=0.438,P均0.05)。血清NT-pro BNP水平诊断HIE的ROC曲线下面积为0.954,最佳诊断界点1034.83 pg/ml。血清CK-MB水平诊断HIE的ROC曲线下面积为0.925,最佳诊断界点42.99 U/L。二者联合检测诊断HIE的ROC曲线下面积为0.979,特异度为88.5%,灵敏度为96.3%,联合检测诊断价值优于CK-MB单独检测,差异具有统计学意义(P0.05),与NT-pro BNP相比无明显差异(P0.05)。结论HIE组新生儿脐带血血清NT-pro BNP、CK-MB水平有不同程度的升高;脐带血血清NT-pro BNP、CK-MB水平可以早期反映HIE病情严重程度;早期联合检测脐带血血清NT-pro BNP、CK-MB可以早期预测HIE的发生和有效评估其严重程度,为早期干预提供理论依据。
[Abstract]:Objective to investigate the changes of serum N-terminal B-type natriuretic peptide (NT-pro BNPs) and myocardial enzymes in neonates with hypoxic-ischemic encephalopathy (HIE) and to evaluate the predictive value of NT-pro BNPs in clinical diagnosis of neonatal HIE. Methods A total of 20 healthy neonates without perinatal asphyxia risk factors and postnatal asphyxia history were selected as control group, and 60 neonates with perinatal asphyxia risk factors at gestational age of 37-42 weeks were selected as observation group. According to the severity of HIE and HIE, the patients were divided into non-HIE group (n = 6), mild HIE group (n = 10), moderate HIE group (n = 36) and severe HIE group (n = 8). The clinical data, electrocardiogram (ECG) and the results of cardiac ultrasound were observed, and the umbilical vein blood (4 ml) was extracted immediately after delivery, and the levels of NT-pro BNPand myocardial enzyme in cord blood were measured. The diagnostic value of serum NT-pro BNP and myocardial enzyme in diagnosing HIE was calculated. Results there was no significant difference in sex, gestational age, body weight, body length and delivery mode between the two groups (P 0.05). The incidence of HIE in the observation group with high risk factors of asphyxia was higher than that in the control group, and the difference was statistically significant (P 0.05). The incidence of abnormal ECG and echocardiography in the observation group was significantly higher than that in the non-HIE group and the control group, and the difference was statistically significant (P 0.05). The serum NT-pro BNP level in the observation group was significantly higher than that in the control group (P 0.05). The level of serum NT-pro BNP in the observation group was significantly higher than that in the non-HIE group and the control group (P 0.05). There was no significant difference in the results of CK-MB between the non-HIE group and the control group. There was a positive correlation between the serum NT-pro BNP level and the CK-MB level in the non-HIE group and the control group. There was a positive correlation between the serum NT-pro BNP level and the CK-MB level. There was a positive correlation between the severity of the disease and the severity of the disease in the HIE group. The area under the ROC curve of serum NT-pro BNP level for HIE diagnosis was 0.954, and the best diagnostic threshold was 1034.83 PG / ml. The area under the ROC curve of serum CK-MB level for HIE diagnosis was 0.925, and the best diagnostic threshold was 42.99 U / L. The area under the ROC curve was 0.979, the specificity was 88.5and the sensitivity was 96.3.The diagnostic value of the combined detection was better than that of CK-MB alone, and the difference was statistically significant (P 0.05), but there was no significant difference compared with NT-pro BNP (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 serum of cord blood can reflect the severity of HIE in early stage. Early combined detection of serum NT-pro BNPK-MB in cord blood can predict the occurrence of HIE and evaluate its severity effectively, and provide theoretical basis for early intervention.
【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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