河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (2): 172-176,196.doi: 10.3969/j.issn.1007-3205.2021.02.011

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新生儿窒息后脑损伤外周血S100β、GFAP的变化及临床意义

  

  1. 福建医科大学附属福州市第一医院儿科，福建 福州 350009
  • 出版日期:2021-02-25 发布日期:2021-03-09
  • 作者简介:陈俊（1986-），女，福建漳平人，福建医科大学附属福州市第一医院主治医师，医学硕士，从事新生儿科疾病诊治研究。
  • 基金资助:
    福州市卫生计生中青年科学研究项目（2018-S-wq4）

Changes of GFAP and S100β in peripheral blood caused by brain injury after neonatal asphyxia and its clinical significance

  1. Department of Pediatrics， the First Affiliated Hospital of Fujian Medical University, Fuzhou 350009， China
  • Online:2021-02-25 Published:2021-03-09

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摘要： 目的  探讨不同程度窒息新生儿血清钙结合蛋白S100β、胶质纤维酸性蛋白（glial fibrillary acidic protein，GFAP）的变化及与行为神经测查方法（neonatal behavioral neurological assessment,NBNA）评分的相关性，为早期预测新生儿脑损伤寻找依据。
方法  选择轻度窒息新生儿（轻度窒息组）38例、重度窒息新生（重度窒息组）16例、正常新生儿（对照组）46例。3组新生儿均于出生4 h内采集标本，采用酶联免疫吸附试验法检测血清S100β和GFAP水平。窒息患儿于入院后3~4 d行头颅影像学检查，出生3 d后行新生儿20项NBNA评分。
结果  轻度窒息组、重度窒息组S100β水平高于对照组，差异有统计学意义（P＜0.05）；3组GFAP水平差异无统计学意义（P＞0.05）。脑损伤组S100β水平高于非脑损伤组，差异有统计学意义（P＜0.05）；2组GFAP水平差异无统计学意义（P＞0.05）。Spearman相关分析显示，新生儿S100β水平与NBNA评分呈负相关（P＜0.05），GFAP水平与NBNA评分无相关（P＞0.05）。回归分析显示，S100β是新生儿脑损伤的影响因素（P＜0.05）。S100β预测窒息后脑损伤的ROC曲线 AUC=0.755，敏感度为77.8%，特异度为77.8%；GFAP预测窒息后脑损伤的ROC曲线的AUC=0.488，敏感度为16.7%，特异度为97.2%。
结论  出生4 h内检测S100β有助于诊断新生儿窒息和窒息后脑损伤，预测窒息后脑损伤的准确性高；出生4 h内GFAP检测特异度高，但敏感度低、准确性低，对诊断窒息和窒息后脑损伤参考价值较小，不建议单独检测。


关键词: 新生儿窒息, 脑损伤, S100蛋白质类, 胶质纤维酸性蛋白

Abstract: Objective  To investigate the changes of serum calcium-binding protein S100β, glial fibrillary acidic protein(GFAP) and their correlation with behavioral neurotest neonatal behavioral neurological assessment(NBNA) scores in postnatal asphyxia neonates of different degrees, and to find the basis for early prediction of neonatal brain injury. 
Methods  A total of 38 cases of mild asphyxia, 16 cases of severe asphyxia and 46 cases of normal asphyxia were selected. The samples of the three groups of newborns were collected within 4 hours after birth, and serum GFAP and S100β concentrations were detected by enzyme-linked immunosorbent assay. All asphyxiated newborns underwent cranial imaging examination three to four days after admission and received Neonatal Behavioral Neurological Assessment(NBNA) score three days after birth. 
Results  The S100β level in mild asphyxia group and severe asphyxia group was significantly higher than that in control group, the difference was statistically significant(P＜0.05).There was no statistically significant difference in GFAP level among three groups(P＞0.05). The S100β level in the brain injury group was significantly higher than that in non-brain injury group, the difference was statistically significant(P＜0.05), and there was no statistically significant difference in GFAP level between two groups(P＞0.05). Spearman correlation analysis showed that Neonatal S100β level was negatively correlated with NBNA score(P＜0.05), the GFAP level was not correlated with NBNA score(P＞0.05). Regression analysis showed that S100β was the influencing factor of neonatal brain injury(P＜0.05). The AUC of the ROC curve of S100β for predicting the brain injury after asphyxia was 0.755, with sensitivity of 77.8% and specificity of 77.8%. The AUC of the ROC curve of GFAP for predicting the brain injury after asphyxia was 0.488, with sensitivity of 16.7% and specificity of 97.2%. 
Conclusion  S100β detection within 4 hours of birth is helpful for the diagnosis of neonatal asphyxia and brain injury after asphyxia, and the accuracy of predicting asphyxia brain injury is high. GFAP detection within 4 hours after birth has high specificity, but low sensitivity and accuracy.It has little reference value for the diagnosis of neonatal asphyxia and brain injury after asphyxia. It is not recommended to detect alone within 4 hours after birth. 


Key words: asphyxia neonatorum, brain injuries, S100 proteins, glial fibrillary acidic protein

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