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发育医学电子杂志  2024, Vol. 12 Issue (3): 166-171    DOI: 10.3969/j.issn.2095-5340.2024.03.002
  围产医学   论著 |新生儿 |
彩色多普勒超声联合血清NSE及5 minApgar评分对新生儿颅内出血的诊断价值及危险因素分析
闫永垒 贺洋洋 梁真真 张晶 黄萍虹 田晓玲 苏金玲 陈丽祺
(承德市中心医院 新生儿科,河北 承德 067000)
Diagnostic value of color Doppler ultrasound combined with serum NSE and 5 min Apgarscore in neonatal intracranial hemorrhage and analysis of risk factors
Yan Yonglei, He Yangyang, Liang Zhenzhen, et al
(Department of Neonatology, Chengde Central Hospital, Hebei, Chengde 067000, China)
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摘要 【摘要】 目的  探讨彩色多普勒超声联合血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)
及5 min Apgar 评分对新生儿颅内出血(intracranial hemorrhage,ICH)的诊断价值及影响ICH 发生的
危险因素。 方法 选取2019 年2 月至2021 年3 月承德市中心医院新生儿科收治的存在颅脑损伤
危险因素的253 例新生儿为研究对象,均接受彩色多普勒超声检查,根据是否存在ICH 分为ICH 组(n=99)和无ICH 组(n=154)。观察并比较两组彩色多普勒超声参数[ 收缩期峰值流速(peak systolicvelocity,PSV)、阻力指数(resistance index,RI)、舒张末期流速(end diastolic velocity,EDV)]、血清NSE
水平、5 min Apgar 评分情况,分析血清NSE 水平、Apgar 评分与彩色多普勒超声参数的相关性及三者
联合检测对新生儿ICH 的诊断价值,并分析ICH 发生的主要影响因素。统计学方法采用独立样本t 检
验、χ2 检验、Pearson 相关性分析、Logistic 回归分析及受试者操作特征(receiver operating characteristic,ROC) 曲线分析。 结果 ICH 组与无ICH 组PSV[(6.4±1.2) cm/s 与(10.1±1.4) cm/s,t=21.628]、RI(0.6±0.1 与0.7±0.1,t=8.144)、EDV[(2.5±0.4) cm/s 与(3.1±0.4) cm/s,t=13.216] 以及5 min Apgar 评分[(6.5±1.7)分与(8.8±1.0)分,t=13.308] 比较,ICH 组均显著低于无ICH 组(P 值均<0.001);血清NSE 水平显著高于无ICH 组[(149.1±10.6) μg/L 与(95.2±10.4)μg/L,t=40.015,P<0.001]。ICH 组血清NSE 水平与彩色多普勒超声参数PSV、RI、EDV 呈负相关(r 值分为-0.573、-0.520、-0.536,P 值均<0.05);5 min Apgar 评分与彩色多普勒超声参数PSV、RI、EDV 呈正相关(r 值分别为0.601、0.529、0.505,P 值均<0.05)。ROC 曲线结果发现,彩色多普勒超声、血清NSE 水平、5 min Apgar 评分联合诊断新生儿ICH 的曲线下面积(area under the curve,AUC)最大,为0.861。单因素分析显示,与无ICH 组比较,ICH 组患儿的胎龄更小,出生体质量、5 min Apgar 评分更低,出生窒息、应用多巴胺、应用机械通气比例及血清NSE 水平更高,差异有统计学意义(P 值均<0.05)。多因素Logistic 回归分析结果显示,胎龄<32 周、出生体质量<1 500 g、血清NSE水平>117.95 μg/L、5 min Apgar 评分<7 分是诱发ICH 的独立危险因素。结论  彩色多普勒超声联合血清NSE 及5 min Apgar 评分可提高ICH 的诊断价值;胎龄<32 周、出生体质量<1 500 g、血清NSE 水平>117.95 μg/L、5 min Apgar 评分<7 分是诱发ICH 的独立危险因素。
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关键词:  新生儿  颅内出血  彩色多普勒超声  神经元特异性烯醇化酶  5 min Apgar 评分  危险因素    
Abstract: 【Abstract】 Objective To investigate the diagnostic value of color Doppler ultrasound combined with
neuron-specific enolase (NSE) and 5 min Apgar score in neonatal intracranial hemorrhage (ICH) and risk factors affecting the occurrence of ICH. Method A total of 253 neonates who underwent color Doppler ultrasound examination to the Department of Neonatology, Chengde Central Hospital from February 2019 to March 2021 were enrolled as study subjects, and they were divided into ICH group (n=99) and non-ICH group (n=154)according to the presence or absence of ICH. The two sets of color Doppler ultrasound parameters [peak systolicvelocity (PSV), resistance index (RI), end diastolic velocity (EDV)], serum NSE level, 5 min Apgar score wereobserved and compared, and the correlation between of Apgar score, color Doppler ultrasound parameters and NSElevel were analyzed. The diagnostic value of the combination of the three in neonatal ICH were analyzed,and the risk factors affecting the occurrence of ICH were analyzed. The statistical methods performedby independent sample t-test, χ2 test, Pearson correlation analysis, Logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Result PSV [(6.4±1.2) cm/s vs (10.1±1.4) cm/s, t=21.628]and RI (0.6±0.1 vs 0.7±0.1, t=8.144), EDV[(2.5±0.4) cm/s vs (3.1±0.4) cm/s, t=13.216] and 5 min Apgarscore [(6.5±1.7) points vs (8.8±1.0) points, t=13.308] in ICH group were significantly lower than those innon-ICH group (all P<0.05), and the serum NSE level was significantly higher than that of non-ICH group[(149.1±10.6) μg/L vs (95.2±10.4) μg/L, t=40.015, P<0.001]. The serum NSE levels in the ICH group were negatively correlated with the color Doppler ultrasound parameters PSV, RI and EDV (r=-0.573, -0.520,-0.536, all P<0.05), and the 5 min Apgar score was positively correlated with the color Doppler ultrasoundparameters PSV, RI and EDV (r=0.601, 0.529, 0.505, all P<0.05). The results of the ROC curve showed thatthe area under the curve (AUC) of color doppler ultrasound, serum NSE and 5 min Apgar score combinedto diagnose neonatal ICH was the largest, which was 0.861. Univariate analysis showed that children in theICH group had a smaller gestational age, lower birth weight, lower 5 min Apgar score, higher proportion ofbirth apnea, dopamine, mechanical ventilation and serum NSE levels compared with the non-ICH group (allP<0.05). Multivariate Logistic regression analysis showed that gestational age <32 weeks, birth weight<1 500 g, serum NSE level >117.95 μg/L, and 5 min Apgar score <7 points were independent risk factorsfor ICH. Conclusion  Color Doppler ultrasound combined with serum NSE and 5 min Apgar score canimprove the diagnostic value of ICH. Gestational age <32 weeks, birth weight <1 500 g, serum NSE level>117.95 μg/L, and 5 min Apgar score <7 points are independent risk factors for ICH.
Key words:  Neonates    Intracranial hemorrhage    Color Doppler ultrasound    Neuron-specific enolase    5 min Apgar score    Risk factors
收稿日期:  2023-07-25                     发布日期:  2024-05-31     
基金资助: 河北省科学技术研究与发展计划项目(202201A007)
通讯作者:  陈丽祺    E-mail:  444793086@qq.com
引用本文:    
闫永垒 贺洋洋 梁真真 张晶 黄萍虹 田晓玲 苏金玲 陈丽祺. 彩色多普勒超声联合血清NSE及5 minApgar评分对新生儿颅内出血的诊断价值及危险因素分析[J]. 发育医学电子杂志, 2024, 12(3): 166-171.
Yan Yonglei, He Yangyang, Liang Zhenzhen, et al. Diagnostic value of color Doppler ultrasound combined with serum NSE and 5 min Apgarscore in neonatal intracranial hemorrhage and analysis of risk factors. Journal of Developmental Medicine(Electronic Version), 2024, 12(3): 166-171.
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