摘要
目的探讨神经肽Y(NYP)和血清淀粉样蛋白A(SAA)检测在新生儿急性胆红素脑病(ABE)诊断中的临床价值及其与血栓素B2(TXB2)和6-酮前列腺素-F1α(6-Keto-PGF1α)的相关性。方法前瞻性选取2021年3月至2022年9月同济大学附属第一妇婴保健院新生儿科收治的重度新生儿高胆红素血症患儿163例作为研究对象。根据是否发生急性胆红素脑病,分为ABE组(n=41)和非ABE组(n=122)。收集两组患儿的临床相关资料,检测血清中NYP、SAA、TXB2和6-Keto-PGF1α水平。受试者工作特征(ROC)曲线分析NYP和SAA在ABE诊断中的临床价值,采用Spearman相关性分析NYP、SAA与TXB2和6-Keto-PGF1α的水平的相关性。结果ABE组患儿的入院时间明显长于非ABE组,败血症或感染占比、新生儿溶血病占比、总胆红素峰值、葡萄糖-6-磷酸脱氢酶(G-6-PD)缺陷占比、总胆红素/白蛋白(B/A)比值均明显高于非ABE组,差异均有统计学意义(P<0.05)。ABE组患儿血清中NYP和SAA水平明显高于非ABE组,差异均有统计学意义(P<0.05)。血清中NYP诊断新生儿ABE的ROC曲线下面积(AUC)为0.823,NYP以396.42 g/L为截断值,诊断的敏感度为81.05%,特异度为73.17%;血清中SAA诊断新生儿ABE的ROC AUC为0.796,NYP以792.16 mg/L为截断值,诊断的敏感度为70.73%,特异度为78.05%;血清中NYP联合SAA诊断新生儿ABE的ROC AUC为0.876,诊断的敏感度为85.37%,特异度为75.61%。ABE组新生儿血清中TXB2水平明显高于非ABE组,6-Keto-PGF1α水平明显低于非ABE组,差异均有统计学意义(P<0.05)。NYP、SAA与TXB2呈正相关(r=0.307、0.313,P<0.001);NYP、SAA与6-Keto-PGF1α呈负相关(r=-0.581、-0.687,P<0.001)。结论ABE新生儿血清中NYP和SAA水平明显升高,对ABE均有一定的诊断价值,NYP和SAA联合诊断效果更佳,而且NYP、SAA与TXB2呈正相关,NYP、SAA与6-Keto-PGF1α呈负相关。
Objective To investigate the clinical value of neuropeptide Y(NYP)and serum amyloid A(SAA)in the diagnosis of acute bilirubin encephalopathy(ABE)in neonates and its correlation with thromboxane B2(TXB2)and 6-Keto-PGF1α(6-Keto-pgF1α).Methods A total of 163 children with severe neonatal hyperbilirubinemia admitted to Department of Neonatology,Shanghai First Maternity and Infant Hospital,School of Medicine,Tongji University,from March 2021 to September 2022 were prospectively selected as the study subjects.According to the occurrence of acute bilirubin encephalopathy,the patients were divided into ABE group(n=41)and non-ABE group(n=122).The clinical data of the two groups were collected,and the serum levels of NYP,SAA,TXB2 and 6-Keto-PGF1αwere detected.The clinical value of NYP and SAA in ABE diagnosis was analyzed by receiver operating characteristic(ROC)curve,and the correlation of NYP and SAA with TXB2 and 6-Keto-PGF1αwas analyzed by Spearman correlation.Results The hospital admission time of children in ABE group was significantly longer than that in non-ABE group,and the proportion of sepsis or infection,the proportion of hemolytic disease in newborns,the peak value of total bilirubin,the defect proportion of glucose-6-phosphate dehydrogenase(G-6-PD),and the ratio of total bilirubin to albumin(B/A)were significantly higher than those in non-ABE group,the differences were statistically significant(P<0.05).The serum levels of NYP and SAA in ABE group were significantly higher than those in non ABE group,the differences were statistically significant(P<0.05).The ROC AUC of serum NYP for diagnosing ABE was 0.823,and the cut-off value of NYP was 396.42 g/L.The diagnostic sensitivity was 81.05%,and the specificity was 73.17%.The ROC AUC of SAA in serum for diagnosing ABE was 0.796,and the cut-off value of NYP was 792.16 mg/L.The diagnostic sensitivity was 70.73%,and the specificity was 78.05%;the ROC AUC of serum NYP combined with SAA in diagnosing ABE was 0.876,the diagnostic sensitivity was 85.37%,and the speci
作者
张文妍
刘金凤
顾晓英
田佳佳
ZHANG Wen-yan;LIU Jin-feng;GU Xiao-ying(Department of Neonatology,Shanghai First Maternity and Infant Hospital,School of Medicine,Tongji University,Shanghai 201204,China;Deparment of Obstetrics and Gynecology,Shanghai First Maternity and Infant Hospital,School of Medicine,Tongji University,Shanghai 201204,China)
出处
《临床和实验医学杂志》
2023年第14期1540-1544,共5页
Journal of Clinical and Experimental Medicine
基金
上海市科委科技辅助支撑项目(编号:19411960500)。
