摘要
目的围产期窒息易诱发新生儿缺氧缺血性脑病(hypoxie ischaemic eneephalopatby,HIE),为新生儿围产期窒息最严重的并发症之一。HIE可导致新生儿发生脑瘫、癫痫和智力障碍等永久性神经功能障碍,同时也是新生儿死亡的重要因素之一。本研究分析血清磷酸肌酸激酶脑型同工酶(creatine phosphokinase BB isoenzyme,CK-BB)和尿乳酸/肌酐早期评估新生儿缺氧缺血性脑病(hypoxie ischaemic eneephalopatby,HIE)的价值。方法选择2013-01-01-2017-01-01驻马店市中心医院收治的HIE新生儿27例作为HIE组,其中轻度11例,中度10例,重度6例。选择同院同期正常出生的足月健康新生儿25名作为对照组。采用IL-1610型血气分析仪分析脐动脉血pH、血二氧化碳分压(partial pressure of carbon dioxide,PCO2)、血氧分压(partial pressure of oxygen,PO2)和碱剩余(base excess,BE)。酶联免疫法测定脐动脉血、出生后6和24h血清CK-BB水平,酶比色法检测出生6h内尿(或出生后第1次)、24和48h内尿乳酸和肌酐水平。分析脐带血CK-BB和出生6h尿乳酸/肌酐,与Apgar评分、脐带血pH、PCO2、PO2和BE等血气指标的相关性。结果 HIE组pH为6.95±0.10,低于对照组的7.24±0.06,t=12.553,P<0.001;PCO2为(51.23±12.7)mm Hg,高于对照组的(42.24±7.71)mm Hg,t=-3.005,P<0.001;PO2为(10.63±3.12)mm Hg,低于对照组的(17.12±5.69)mm Hg,t=5.152,P<0.001;BE为(-15.15±3.71)mmol/L,低于对照组(-5.12±3.02)mmol/L,t=10.640,P<0.001;脐带血血清CK-BB为(10.14±3.12)U/L,高于对照组的(3.14±2.59)U/L,t=-8.764,P<0.001;出生6h血清CK-BB为(10.79±3.21)U/L,高于对照组的(5.62±2.72),t=-6.240,P<0.001;24h血清CK-BB为(7.52±4.32)U/L,高于对照组的(4.13±1.75)U/L,t=-3.654,P<0.001。出生6h内尿乳酸/肌酐为3.32±2.02,高于对照组的0.28±0.07,t=-7.515,P<0.001;24h内为1.51±0.23,高于对照组的0.27±0.09,t=-25.214,P<0.001;48h内为1.23±0.16,高于对照组的0.24±0.08,t=-18.244,P<0.001。HIE轻度组、中度组及重度组新生儿Apgar评分、脐动脉血气指标、CK-BB和出生6h尿乳酸/肌酐比较,差异有统计学意义,均P<0.01。脐带血CK-BB、出生6h尿乳酸/肌酐,与Apgar评分及脐带血pH、PO2、BE呈负相关,均P<0.01;与PCO2呈正相关,均P<0.01。结论新生儿脐带血CK-BB和6h尿乳酸/肌酐可以作为HIE早期评估脑损伤严重程度的指标,便于早期及时对HIE新生儿进行治疗。
OBJECTIVE Perinatal asphyxia is easy to induce hypoxic ischaemic eneephalopatby(HIE),which is the most serious complication of neonatal perinatal asphyxia.HIE can cause permanent neurological dysfunction such as cerebral palsy,epilepsy,mental retardation,and is also an important factor in neonatal death.This study aims to analyze the value of serum phosphocreatine kinase BB isoenzyme(CK-BB)and urinary lactate/creatinine in the early evaluation of neonatal HIE.METHODS 27 HIE neonates admitted to Zhumadian Central Hospital from January 1,2013 to January 1,2017 were selected as HIE group,including 11 mild cases,10 moderate cases and 6severe cases.25 healthy newborns with normal birth at the same time were selected as the control group.Umbilical arterial blood pH,partial pressure of carbon dioxide(PCO2),partial pressure of oxygen(PO2),and base excess(BE)were analyzed using an IL-1610 blood gas analyzer.The serum CK-BB levels in umbilical arterial blood,in neonatal peripheral blood at 6hand 24 hafter birth were measured by enzyme-linked immunosorbent assay.Enzyme colorimetric assay was used to detect urinary uric acid and creatinine levels with in 6hof birth(or 1st after birth),24 hand 48h.The correlation between cord blood CK-BB and 6hurinary lactate/creatinine ratio and Apgar score,cord blood pH,PCO2,PO2,BE and other blood gas indexes were analyzed.RESULTS The pH of HIE group was 6.95±0.10,which was lower than that of the control group 7.24±0.06,t=12.553,P<0.001.PCO2was(51.23±12.7)mm Hg,which was higher than that in the control group(42.24±7.71)mm Hg,t=-3.005,P<0.001.PO2 was(10.63±3.12)mm Hg,which is lower than that of the control group(17.12±5.69)mm Hg,t=5.152,P<0.001.BE was(-15.15±3.71)mmol/L,lower than that in the control group(-5.12±3.02)mm Hg,t=10.640,P<0.001.The cord blood serum CK-BB was(10.14±3.12)U/L,higher than(3.14±2.59)U/L in the control group,t=-8.764,P<0.001.The serum CK-BB was(10.79±3.21)U/L at 6hafter birth,higher than(5.62±2.72)U/L in the control group,t=-6.240,P<0.001.The serum CK-BB at 24 hafter birth was(7.52±4.32)U/L,which was higher than(4.13±1.75)U/L in the control group,t=-3.654,P<0.001.The ratio of urinary lactate/creatinine with in 6hours of birth was(3.32±2.02),which was higher than(0.28±0.07)in the control group,t=-7.515,P<0.001.The ratio of urinary lactate/creatinine with in 24 hours was(1.51±0.23),higher than(0.27±0.09)in the control,t=-25.214,P<0.001.The urinary lactate/creatinine ratio was(1.23±0.16)with in48 h,which was higher than(0.24±0.08)in the control group,t=-18.244,P<0.001.There were significant differences in the Apgar score,umbilical arterial blood gas index,CK-BB and 6hurinary lactate/creatinine ratio between the HIE mild group,the moderate group and the severe group(all P<0.01).Cord blood CK-BB and 6hurinary lactate/creatinine ratio were negatively correlated with Apgar score,cord blood pH,PO2,BE(all P<0.01),and positively correlated with PCO2(all P<0.01).COCLUSION The CK-BB of neonatal cord blood and 6hurinary lactate/creatinine ratio can be used as an early indicator of the severity of brain injury in HIE,which is convenient for early and timely treatment of HIE neonates.
作者
张剑春
孙丁
ZHANG Jian-chun;SUN Ding(Zhumadian Central Hospital,Zhumadian 463000,P.R.China)
出处
《社区医学杂志》
2018年第20期1539-1543,共5页
Journal Of Community Medicine
关键词
脐带血CK-BB
尿乳酸/肌酐
新生儿
缺氧缺血性脑病
cord blood CK-BB
urinary lactic acid/creatinine
neonatal
hypoxie ischaemic eneephalopatby
作者简介
通讯作者:张剑春,女,河南驻马店人,主治医师,主要从事新生儿临床医疗的研究工作。E-mail:zjchunzmd@163.com.
