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目的观察血清酶活性在新生儿窒息的变化,探讨其与脑损伤程度的相关性及预后。方法103例窒息新生儿(轻度69例,重度34例)和40例正常新生儿作对照,均在生后24~48h测定磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸酶(-αHBDH)、谷草转氨酶(AST);并于生后第2d做神经行为测定(NBNA),分析其与各个血清酶之间的相关性;100例窒息组患儿(3例因合并多脏器功能衰竭死亡)均于生后4~7d做头颅CT检查;并于生后第3个月及第6个月随访神经发育情况。结果轻度窒息组及重度窒息组患儿血清酶活性均高于对照组(P<0.01),与临床分度呈正相关(窒息程度越重,血清酶活性越高,NBNA评分越低);-αHBDH、LDH、CK、CK-MB、AST与NBNA评分有一定的相关性(相关系数r分别为-0.797、-0.853、-0.826、-0511、-0.585);临床分度与头颅CT密切相关;血清酶α-HBDH、LDH、CK对预后判断具有一定的敏感性和特异性。结论α-羟丁酸酶、乳酸脱氢酶、磷酸肌酸激酶对早期评价脑损伤程度及判断预后具有重要价值,而磷酸肌酸激酶同工酶(心肌型)、谷草转氨酶活性升高仅提示可能存在脑损伤,不能判断其损伤程度及预后。
Objective To observe the changes of serum enzyme activity in neonatal asphyxia and to explore its correlation with prognosis of brain injury. Methods 103 neonates with asphyxia (mild 69 cases, severe 34 cases) and 40 normal newborns were enrolled as control. The levels of creatine phosphokinase (CK), creatine phosphokinase (CK) -MB), lactate dehydrogenase (LDH), α-hydroxybutyrate (-HBDH) and aspartate aminotransferase (AST) were measured. And neurobehavioral assay (NBNA) ; 100 children with asphyxia group (3 died of multiple organ failure) were examined by cranial CT 4 ~ 7 days after birth; and the nerves were followed up at 3 and 6 months after birth Development. Results Serum enzyme activities in children with mild asphyxia group and severe asphyxia group were significantly higher than those in control group (P <0.01), and were positively correlated with clinical grade (heavier asphyxia, higher serum enzyme activity, lower NBNA score); - The correlation between αHBDH, LDH, CK, CK-MB, AST and NBNA was correlated (r = -0.797, -0.853, -0.826, -0511, -0.585, respectively) Serum enzymes α-HBDH, LDH, CK have a certain sensitivity and specificity for the prognosis. Conclusions α-Hydroxybutyrate, lactate dehydrogenase and creatine phosphokinase are of great value in the early evaluation of the degree of brain injury and prognosis. However, the increase of creatine phosphokinase (astrocyte) and aspartate aminotransferase There may be brain damage, can not determine the extent of their injury and prognosis.