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目的探讨血浆S100B蛋白对缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)新生儿脑损伤的临床意义。方法选择54例临床诊断为HIE的新生儿在出生12 h时抽血检测S100B、神经元特异性烯醇化酶(neuron specificenolase,NSE)及脑型肌酸激酶同功酶(creatine kinaes BBisozyme,CK-BB),与47例非HIE的窒息新生儿和22例健康新生儿进行对照比较。评价敏感性和特异性,绘制ROC曲线,计算ROC曲线下面积。结果出生12 h时HIE患儿血浆S100B、NSE和CK-BB阳性率显著高于窒息组和对照组(均P<0.01),S100B对HIE的敏感性为88.89%,特异性为82.61%,之和高于NSE及CK-BB。S100B的ROC曲线下面积最大(面积:0.950;95%可信区间0.918-0.983),临床诊断效能高于NSE及CK-BB。结论HIE患儿出生12 h时血浆S100B、NSE和CK-BB均能预示HIE患儿的脑部损伤,S100B阳性率最高,三指标联合检测,有助于HIE的早期诊断和病情判断。
Objective To investigate the clinical significance of plasma S100B protein in brain injury in neonates with hypoxic ischemic encephalopathy (HIE). Methods Fifty-four neonates with HIE were selected to take blood samples for detection of S100B, neuron-specific enolase (NSE) and creatine kinaes BBisozyme (CK- BB) compared with 47 non-HIE asphyxiated newborns and 22 healthy newborns. Evaluation of sensitivity and specificity, draw ROC curve, calculate the area under the ROC curve. Results The positive rates of S100B, NSE and CK-BB in children with HIE at 12 h after birth were significantly higher than those in asphyxia group and control group (all P <0.01). The sensitivity and specificity of S100B to HIE were 88.89% and 82.61%, respectively And higher than NSE and CK-BB. The area under the ROC curve of S100B was the largest (area: 0.950; 95% confidence interval 0.918-0.983). The clinical diagnostic efficacy was higher than NSE and CK-BB. Conclusions The plasma levels of S100B, NSE and CK-BB at 12 h after birth in children with HIE can predict brain injury in children with HIE. The positive rate of S100B is the highest in HIE children. Combined detection of these three indexes is helpful for the early diagnosis and assessment of HIE.