新生儿缺氧缺血性脑病预后的早期评估指标

目的　探讨神经元特异性烯醇酶 (NSE)、内源性一氧化碳 (CO)、新生儿行为神经测定 (NBNA)、临床分度法和CT分度法等方法在新生儿缺氧缺血性脑病 (HIE)预后判断早期评估中的意义。方法　对 30例HIE患儿在生后第 2天检测血清NSE浓度和血浆CO水平 ,生后 7d内进行临床分度、CT分度和NBNA评分 ,于生后 6月 - 1岁进行神经发育随访 ,以 10例足月新生儿为对照组。结果　HIE组血清NSE、血浆CO浓度明显高于对照组 (P均 <0 .0 0 1) ;血清NSE、血浆CO浓度之间 ,及它们分别与HIE临床分度、CT分度呈正相关 ,与NBNA评分呈负相关 ;临床分度法、CT分度法、NBNA、血清NSE及血浆CO浓度检测预测预后的敏感性分别为 10 0 %、10 0 %、85 .71%、10 0 %和 83.33% ,特异性分别为 4 5 .4 5 %、4 5 .4 5 %、5 1.6 6 %、5 8.33%和 5 8.33%。结论　临床分度法是预测HIE预后的基础指标 ,血清NSE浓度变化对早期预测HIE预后有较高的价值

Indices for early assessment of prognosis of neonatal hypoxic-ischemic encephalopathy

Objective To study the effects of different methods to determine early prognosis of neonatal hypoxic-ischemic encephalopathy (HIE). Methods The levels of serum neuron specific enolase (NSE) and plasma carbon monoxide (CO) were detected in 30 neonates with HIE on the second day after birth. The brain CT, neonatal behavioral neurological assessment (NBNA) were carried out within 7 days after birth to assess the degree of brain injury. Development of intelligence was tested during 6 months ～ 1 year old. Ten healthy neonates served as controls. Results The serum NSE and plasma CO levels of HIE neonates were significantly higher than those of the normal control (P< 0.01). The level of serum NSE was positively correlated with the level of plasma CO. The levels of serum NSE and plasma CO were positively correlated with clinical degree of HIE and degree of CT, but negatively correlated with NBNA. The sensitivity of clinical degree, CT degree, NBNA, serum NSE and plasma CO levels to predict prognosis were 100%, 100%, 85.71%, 100% and 83.33%, respectively. The specificity of them was 45.45%, 45.45%, 51.66%, 58.33%, and 58.33%, respectively. Conclusion While clinical degree is a basic marker to predict prognosis of HIE, level of serum NSE as a new reference index serves as a more important value marker in early determination of the prognosis of HIE.