摘要
目的通过检测新生儿重症高胆红素血症患儿血清神经元特异性烯醇化酶(NSE)及头颅MRI的检查,早期发现新生儿胆红素脑损伤,以指导积极的换血治疗。方法选择本院2012-11—2014-06收治的新生儿重症高胆红素血症患儿60例与胆红素脑病患儿25例,检测血清NSE及头颅MRI,分析不同胆红素水平下NSE值及头颅MRI的变化,胆红素脑病及MRI有脑损伤的(苍白球信号改变)高胆患儿均进行换血治疗,其余无脑损伤患儿行光疗,复查NSE及MRI。结果重症高胆红素患儿血清NSE均升高,而胆红素脑病患儿升高更明显,差异有统计学意义(P<0.05)。60例重症高胆红素血症患儿中发现4例有胆红素脑损害的MRI改变,25例胆红素脑病中发现14例有胆红素脑损伤的MRI改变,换血治疗后24h复查NSE均迅速下降50%以上,而4例MRI均在1月时恢复正常。光疗治疗后的NSE在24h下降30%,与换血治疗相比,差异有统计学意义(P<0.05)。结论血清NSE水平结合MRI检查可反映早期脑损伤,有脑损伤患儿NSE值与无脑损伤患儿的NSE值有明显差别,换血治疗后NSE下降程度较光疗更明显。高胆红素血症患儿换血治疗可参考NSE值,以防止后遗症的发生。
Objective To study the effect of the early detections of serum neuron-specific enolase （NSE） levels and brain MRI of neonatal hyperbilirubinemia in order to find neonatal bilirubin brain injury and guide the positive exchange trans- fusion therapy in time. Methods We detected serum NSE levels and brain MRI of 60 cases with severe neonatal hyperbilirubi- nemia and 25 cases with neonatal bilirubin encephalopathy in our hospital from December 2010 to December 2013. Then NSE values and the change of brain MRI at different levels of bilirubin were analyzed. Neonates with bilirubin encephalopathy and hyperbilirubinemia accompanied by MRI brain damage （signal change of globus pallidus） were performed by exchange transfu- sion therapy at 24 hours, and the remaining neonates without brain damage were treated by phototherapy. Finally we reexam- ined serum NSE levels and MRI. Results Serum NSE levels of both severe neonatal hyperbilirubinemia and neonatal bilirubin encephalopathy increased obviously, and neonatal bilirubin encephalopathy had higher levels （P〈0.05）. We found that four cases among 60 severe hyperlipidemia neonates and 14 cases among 25 bilirubin encephalopathy neonates were complicated with MRI change of bilirubin brain damage, whose NSE levels were declined by more than 5% at 24 hours after exchange transfu- sion therapy, and the MRI recovered at one-month visit in 4 cases. Serum NSE levels at 24 hours after phototherapy treatment decreased by 30% with significant difference compared with exchange transfusion therapy. Conclusions Serum NSE levels with MRI examination can early reflect brain damage, and serum NSE values of brain damage neonates have significant differ- ent relative to neonates without brain damage. Exchange transfusion therapy may take advantage over phototherapy in terms of declining NSE levels. Thus, neonatal hyperbilirubinemia can receive exchange transfusion therapy based on NSE values to pre- vent the occurrence of complications.
出处
《中国实用神经疾病杂志》
2016年第5期2-5,共4页
Chinese Journal of Practical Nervous Diseases
基金
海南省卫生厅资助课题
项目编号13A210283
