Evaluation of Urinary S100B Protein Level and Lactate/Creatinine Ratio for Early Diagnosis and Prognostic Prediction of Neonatal Hypoxic-Ischemic Encephalopathy
Evaluation of Urinary S100B Protein Level and Lactate/Creatinine Ratio for Early Diagnosis and Prognostic Prediction of Neonatal Hypoxic-Ischemic Encephalopathy
复制标题
尿液 S100B 蛋白水平和乳酸/肌酐比值对新生儿缺氧缺血性脑病早期诊断和预后预测的评估
DOI：
10.1159/000227292
复制
发表时间：
2010-01-01
期刊：
影响因子：
2.5
通讯作者：
Ai, Ting
中科院分区：
文献类型：
--
作者：
Liu, Li;Zheng, Chong-xun;Ai, Ting
背景资料：早期发现和预防新生儿缺氧缺血性脑病（HIE）可降低新生儿死亡率和神经功能障碍。目的：探讨尿S100 B和乳酸/肌酐比值对新生儿缺氧缺血性脑病（HIE）的诊断及预后的价值。方法：选择足月新生儿HIE患儿78例，正常新生儿25例。新生儿行为神经评估（NBNA）和发育筛查测试进行评分。采用S100 B酶联免疫吸附法测定尿S100 B蛋白浓度，酶比色法测定尿乳酸和肌酐水平。结果如下：HIE组新生儿生后1- 3d尿S100 B水平及第1天乳酸/肌酐比值均显著高于对照组。两项指标均与HIE临床分级呈正相关。以生后第3天血清S100 B水平为0.47 μg/l作为判断HIE的临界值，其敏感性为90%，特异性为92%。第1天乳酸/肌酐比值大于0.55显示出最高的敏感性（92%）和特异性（90%）。这两个指标的结合提高了敏感性和特异性分别为99%和97%。出生后第1天乳酸/肌酐比值和出生后第1-3天S100 B水平与出生后第3、7和14天NBNA评分呈负相关。对36例生后6个月内的HIE患儿进行发育筛查试验，发现中、重度HIE患儿65%发育商异常。结论：提示早期检测HIE患儿尿S100 B水平和乳酸/肌酐比值是一种实用、简便、敏感的方法，可提高HIE患儿生后第3天的诊断和预后判断。
Background: Early identification and prevention of hypoxic-ischemic encephalopathy (HIE) in newborns may reduce neonatal mortality and neurological dysfunction. Objective: To analyze the diagnostic and prognostic values of urinary S100B level and lactate/creatinine ratio in newborns with HIE. Methods: Seventy-eight full-term newborns with HIE and 25 normal newborns were enrolled. The Neonatal Behavioral Neurological Assessment (NBNA) and Developmental Screening Test were scored. The concentration of urinary S100B protein was determined using the S100B enzyme-linked immunosorbent assay and the levels of urinary lactate and creatinine were measured with the enzyme colorimetric method. Results: Urinary S100B level on days 1–3 after birth and lactate/creatinine ratio on day 1 were significantly higher in newborns with HIE than those in the control group. Both indexes were positively correlated with the clinical grading of HIE. A cutoff value for the S100B level of 0.47 μg/l on day 3 after birth had a sensitivity of 90% and specificity of 92% for prediction of HIE. A lactate/creatinine ratio of more than 0.55 on day 1 showed the highest sensitivity (92%) and specificity (90%). A combination of both indexes improved the sensitivity and specificity to 99 and 97%, respectively. A negative correlation of both lactate/creatinine ratio on day 1 and S100B level on days 1–3 after birth with the NBNA score was identified on days 3, 7 and 14 after birth. The Developmental Screening Test score of 36 newborns with HIE within 6 months after birth showed that 65% of infants with moderate and high HIE had an abnormal developmental quotient. Conclusion: These data suggest that early measurement of both S100B level and lactate/creatinine ratio in the urine of newborns with HIE is a practical convenient and sensitive way to improve diagnosis on the third day of life and prognostic prediction of HIE.