新生儿缺氧缺血性脑病脑电图背景活动及血清神经元特异性烯醇化酶变化与临床意义

Changes of electroencephalographic background patterns and serum neuron specific enolase levels in neonates with hypoxic-ischemic encephalopathy

摘要:

目的：新生儿期最常见的脑损伤疾病为新生儿重度窒息所致的缺氧缺血性脑病(HIE)，可遗留神经系统后遗症。该研究通过检测新生儿HIE患儿脑电图（EEG）和血清神经元特异性烯醇化酶（NSE），研究新生儿HIE脑电图背景活动及NSE的变化。探讨它们对HIE患儿病情进展、病情程度、预后判断的价值。方法：选择符合新生儿HIE诊断标准的病例58例，分轻度HIE组和中重度HIE组，同期选择产科健康新生儿30例为对照组；各组在生后12~24 h、7~10 d抽血行血清NSE检测；HIE组在生后24 h至8 d内（早期）、28~30 d（恢复期）行脑电图检查；同等条件与时间检测健康对照组脑电图，并对HIE患儿进行随访。结果：HIE组早期脑电图异常率 94.8%(55/58)显著高于健康对照组6.7%(2/30)，差异有显著性意义（P<0.01），中重度HIE组早期脑电图背景活动异常率90.0%(18/20)显著高于轻度HIE组5.2%(2/38)，（P<0.01），早期脑电图背景活动异常患儿预后不良率达 72.2％（13/18），HIE组生后12~24 h血清NSE明显高于健康对照组，差异有统计学意义（P<0.01），早期脑电图背景活动异常和生后12~24 h NSE显著升高与HIE患儿病情分度呈正相关，恢复期患儿脑电图背景活动异常者，绝大多数有神经系统后遗症，发生率达87.5%（7/8）。结论：脑电图背景活动和NSE可作为HIE患儿病情判断、临床分度和预后评估有力的依据。［中国当代儿科杂志，2009，11（3）：173-176］

Abstract:

OBJECTIVE: To examine electroencephalographic (EEG) background patterns and serum neuron specific enolase (NSE) levels in neonates with hypoxic-ischemic encephalopathy (HIE) in order to study their roles in assessing clinical progress, severity and prognosis in children with HIE. METHODS: A total of 58 neonates with HIE, including 38 cases of mild, 12 cases of moderate and 8 cases of severe HIE, were enrolled. Thirty normal neonates were used as the control group. Serum NES levels were measured by radioimmunoassay 12-24 hrs and 7-10 days after birth. EEG examination was performed 24 hrs-18 days of age (early stage) and 28-30 days of age (convalescence stage). The neonates with HIE were followed-up, with a duration of 6 months to 3 years. RESULTS: Fifty-five neonates with HIE (94.8%) showed EEG abnormalities in the early stage, but only 2 patients (6.7%) in the control group (P<0.01). EEG background patterns abnormalities in the early stage were found in 90.0% (18/20) of moderate-severe HIE neonates. The proportion was significantly higher than that in the mild HIE group ［5.2% (2/38); P<0.01］. Thirteen (72.2%) out of 18 patients with early EEG background patterns abnormalities had poor outcomes. Serum levels of NES in the HIE group were significantly higher than those in the control group 12-24 hrs after birth (P<0.01). EEG background patterns abnormalities and increased serum levels of NES 12-24 hrs after birth were consistent with the clinical grading of HIE. Most of neonates ［87.5% (7/8)］ who showed abnormal EEG background patterns at the convalescence stage had neurological sequelae. CONCLUSIONS: EEG background patterns and serum NSE levels may be useful in assessment of disease severity and neurological outcome in children with HIE.［Chin J Contemp Pediatr, 2009, 11 (3):173-176］