新生儿缺血缺氧性脑病血清CK-GBB、ET-1、ADM水平变化及与新生儿神经行为评分的关系

Changes in serum CK-BB, ET-1, and ADM levels in neonatal hypoxic-ischemic encephalopathy and the relationship with neonatal behavioral neurological assessment scores

摘要

目的 探究新生儿缺氧缺血性脑病(NHIE)血清脑型肌酸激酶同功酶(CK-BB)、内毒素-1(ET-1)、肾上腺髓质素(ADM)水平变化及与新生儿神经行为评分(NBNA)的关系。方法 选择2019年1月至2023年12月北京市通州区妇幼保健院收治的96例NHIE患儿及同期50例健康新生儿为研究对象,分别纳入NHIE组及健康组,比较两组血清CK-BB、ET-1、ADM水平及NBNA评分的差异.参照NHIE诊疗指南将患儿分为轻度组(n=34)、中度组(n=40)及重度组(n=22),比较各组上述指标的变化.应用Spearman相关分析CK-BB、ET-1、ADM与神经行为发育的关系。结果 NHIE组血清CK-BB、ET-1、ADM水平均高于健康组,NBNA各维度评分及总分均低于健康组,差异有统计学意义(t值介于11.776~40.361之间,P<0.05);NHIE患儿重度组CK-BB、ET-1、ADM水平均高于轻中度组,NBNA评分低于轻中度组,差异有统计学意义(F值介于59.459~164.311之间,P<0.05);NHIE患儿NBNA评分异常组CK-BB、ET-1、ADM水平均高于NBNA评分正常组,差异有统计学意义(t值介于8.539~14.406之间,P<0.05);Spearman相关分析结果显示,NHIE患儿血清CK-BB、ET-1、ADM水平与NBNA评分呈负相关性(r值分别为-0.799、-0.816、-0.837,P<0.05)。结论 血清CK-BB、ET-1、ADM在NHIE患儿中高表达,且与NBNA评分呈负相关性,其水平越高提示神经行为发育状态越差,有可能作为临床预测神经发育结局的重要标志物.

Abstract

Objective To investigate the changes in serum creatine kinase brain isoenzyme (CK-BB), endothelin-1 (ET-1), and adrenomedullin (ADM) levels in neonates with hypoxic-ischemic encephalopathy (NHIE), and their relationship with neonatal behavioral neurological assessment (NBNA) scores. Methods A total of 96 neonates with NHIE admitted to Tongzhou District Maternal and Child Health Hospital, Beijing, from January 2019 to December 2023 were enrolled in the NHIE group, along with 50 healthy neonates as the control group. Serum CK-BB, ET-1, ADM levels and NBNA scores were compared between the two groups. According to the NHIE diagnosis and treatment guidelines, patients in the NHIE group were classified into mild (n=34), moderate (n=40), and severe (n=22) subgroups, and differences in the above indicators were compared among these subgroups. Spearman correlation analysis was used to assess the relationships between CK-BB, ET-1, ADM and neurobehavioral development. Results Serum levels of CK-BB, ET-1, and ADM in the NHIE group were significantly higher than those in the healthy group, while NBNA scores (both in individual domains and total score) were significantly lower (t=11.776-40.361, P<0.05). In NHIE subgroups, the severe group showed significantly higher levels of CK-BB, ET-1, and ADM, and lower NBNA scores compared to the mild and moderate groups (F=59.459-164.311, P<0.05). NHIE infants with abnormal NBNA scores had significantly higher CK-BB, ET-1, and ADM levels compared to those with normal scores (t=8.539-14.406, P<0.05). Spearman analysis showed that serum CK-BB, ET-1, and ADM levels were negatively correlated with NBNA scores (r=-0.799, -0.816 and -0.837, respectively, P<0.05). Conclusion Serum CK-BB, ET-1, and ADM are highly expressed in neonates with NHIE and are negatively correlated with NBNA scores. Elevated levels of these markers suggest poorer neurobehavioral development and may serve as important biomarkers for predicting neurodevelopmental outcomes in clinical practice.

关键词

新生儿缺氧缺血性脑病 / 脑型肌酸激酶同功酶 / 内毒素-1 / 肾上腺髓质素 / 神经行为发育 / 相关性

Key words

neonatal hypoxic-ischemic encephalopathy / creatine kinase BB isoenzyme / endotoxin-1 / adrenomedullin / neurobehavioral development / correlation

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基金资助

陕西省重点研发计划项目(2020SFG741)