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发育医学电子杂志  2022, Vol. 10 Issue (6): 423-427    DOI: 10.3969/j.issn.2095-5340.2022.06.004
  围产医学   论著 |新生儿 |
新生儿缺氧缺血性脑病血清神经丝蛋白轻链多肽表达水平及与预后的关系
马燕春  王洪  蒲荣 
1. 青 海 省 妇 女 儿 童 医 院  急 诊 内 科, 青 海  西 宁810700;2. 青海省妇女儿童医院 儿科,青海 西宁 810700
Expression level of neurofilament light polypeptide in serum of neonates with hypoxicischemic encephalopathy and its relationship with prognosis
Ma Yanchun, Wang Hong , Pu Rong
1. Department of Emergency, Qinghai Province Women and Children's Hospital , Qinghai, Xining 810700, China; 2. Department of Pediatrics, Qinghai Province Women and Children's Hospital, Qinghai, Xining 810700, China
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摘要 【摘要】 目的  观察新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)血清神经丝蛋白
轻链多肽(neurofilament light polypeptide,NF-L)表达水平及与预后的关系。 方法 选取 2018 年 3 月
至 2019 年 3 月青海省妇女儿童医院收治的 124 例 HIE 患儿纳入研究组,根据 HIE 临床严重程度分为
轻度(n=41)、中度(n=47)、重度(n=36);并将同期出生的 125 例健康新生儿纳入对照组。血清 NF-L 水平采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)进行检测,比较研究组与对照组、不同严重程度 HIE 患儿的 NF-L 水平,采用受试者操作特性(receiver operator characteristic,ROC)曲线分析其对 HIE 患儿预后不良的预测价值。统计学方法采用 t 检验、单因素方差分析、χ2 检验。  研究组患儿血清 NF-L 水平明显高于对照组[(145.9±30.8)与(1.3±0.4)ng/L],差异有统计学意义(t=52.460,P<0.05)。不同严重程度 HIE 患儿性别、出生胎龄、出生体质量比较,差异均无统计学意义(P均 >0.05)。轻、中、重度患儿血清 NF-L 水平[(116.4±15.7)、(153.2±20.9)(170.0±28.2) ng/L]比较,差异有统计学意义(F=61.996,P<0.001);进一步两两比较,重度和中度患儿血清 NF-L 水平均高于轻度患儿,重度患儿血清 NF-L 水平高于中度患儿(P 值均 <0.05)。轻、中、重度 HIE 患儿预后不良比例[0.0% (0/41)、34.0%(16/47)与 61.1%(22/36)]比较,差异有统计学意义(χ2=34.093,P<0.001);进一步两两比较,重度和中度患儿预后不良比例均高于轻度患儿,重度患儿预后不良比例高于中度患儿(P 值均 <0.05)。预后不良患儿血清 NF-L 水平高于预后良好患[(169.8±26.7)与(135.3±20.4)ng/L],差异有统计学意义(t=7.872,P<0.001)。ROC 曲线分析显示,血清中 NF-L 水平预测 HIE 患儿不良预后的曲线下面积为 0.889(95%CI:0.827~0.951),截断值为 140.6 ng/L,其灵敏度为 85.7%、特异度为 79.8%。  不同严重程度 HIE 患儿的预后情况不同,NF-L 可作为判定预后的血清指标,在临床上具有一定的参考价值。
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关键词:  新生儿缺氧缺血性脑病  血清  神经丝蛋白轻链多肽  预后  受试者操作特性曲线    
Abstract: 【Abstract】 Objective To observe the expression level of neurofilament light polypeptide (NF-L) in serum of neonatal hypoxic-ischemic encephalopathy (HIE) and its relationship with prognosis. Method A total of 124 children with HIE admitted to Qinghai Province Women and Children's Hospital from March 2018 to March 2019 were included in the study group, according to HIE clinical severity classification, they weredivided into mild (n=41), moderate (n=47) and severe (n=36) ; and 125 healthy neonates born in the same period were included in the control group. Enzyme linked immunosorbent assay (ELISA) was used to detect the level of NF-L in serum, and to compare the level of NF-L between the study group, the control group and different severity HIE; receiver operator characteristic (ROC) curve was used to analyze its predictive value for the poor prognosis of children with HIE. Statistical methods performed by t-test, one-way ANOVA, χ2 test. Result The level of NF-L in the study group was significantly higher than that in the control group [(145.9±30.8) vs (1.3±0.4) ng/L], and the difference was statistically significant (t=52.460, P<0.05). There were no significant differences in gender, gestational age at birth and birth weight among children with different severity of HIE (all P>0.05). The levels of NF-L in serum of mild, moderate and severe children [(116.4±15.7) , (153.2±20.9) and (170.0±28.2) ng/L] were significantly different (F=61.996, P<0.001). Further pairwise comparison showed that the serum level of NF-L in severe and moderate children was higher than that in mild children, and the serum levels of NF-L in severe children were higher than those in moderate children (all P<0.05). The proportion of poor prognosis in children with mild, moderate and severe HIE was compared [0.0% (0/41), 34.0% (16/47) and 61.1% (22/36)], and the difference was statistically significant 2=34.093, P<0.001). Further pairwise comparison showed that the proportion of severe and moderate children with poor prognosis was higher than that of mild children, and the proportion of severe children with poor prognosis was higher than that of moderate children (all P<0.05). The level of NF-L in the poor prognosis group was higher than that in the good prognosis group [(169.8±26.7) vs (135.3±20.4) ng/L], and the difference was statistically 
significant (t=7.872, P<0.001). ROC curve showed that the area under the curve of serum NF-L level in predicting the adverse prognosis of HIE children was 0.889 (95%CI: 0.827-0.951), and the cut-off value was 140.6 ng/L, its sensitivity was 85.7% and specificity was 79.8%. Conclusion The prognosis of HIE children with different severity is different. NF-L can be used as a serum index to determine the prognosis, which has certain reference value in clinic.
Key words:  Neonatal hypoxic-ischemic encephalopathy    Serum    Neurofilament light polypeptide    Prognosis    Receiver operator characteristic curve
收稿日期:  2022-03-28                     发布日期:  2022-11-29     
基金资助: 青海省卫健委医药卫生科技项目(2020-wjzdx-93)
通讯作者:  蒲荣    E-mail:  wm15297128616@163.com
引用本文:    
马燕春  王洪  蒲荣 .
新生儿缺氧缺血性脑病血清神经丝蛋白轻链多肽表达水平及与预后的关系
[J]. 发育医学电子杂志, 2022, 10(6): 423-427.
Ma Yanchun, Wang Hong , Pu Rong. Expression level of neurofilament light polypeptide in serum of neonates with hypoxicischemic encephalopathy and its relationship with prognosis. Journal of Developmental Medicine(Electronic Version), 2022, 10(6): 423-427.
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