神经元特异性烯醇化酶及乳酸水平与新生儿窒息心肌损伤严重程度的关系

The relationship of neuron specific enolase and lactate levels with the severity of neonatal asphyxia myocardial injury

摘要:

目的 探讨神经元特异性烯醇化酶（NSE）和乳酸水平在评估新生儿窒息后心肌损伤严重程度中的应用价值。方法 回顾性分析2020年10月—2023年10月常州市妇幼保健院收治的120例新生儿窒息并合并心肌损伤的患儿。根据心肌损伤标志物心肌肌钙蛋白Ⅰ（cTnⅠ）水平，将患儿分为轻度组（79例）和重度组（41例），并选取同期在该院出生的60例健康新生儿作为对照组。比较3组的血清NSE、乳酸、脑钠肽及乳酸脱氢酶（LDH）水平。采用Spearman相关性分析血清NSE、乳酸与心肌损伤标志物的相关性；绘制受试者工作特征（ROC）曲线分析这些指标对新生儿窒息心肌损伤严重程度的诊断价值。结果 重度组的NSE和乳酸水平高于轻度组和对照组（P <0.05），且轻度组的NSE和乳酸水平高于对照组（P <0.05）。NSE与cTnⅠ、脑钠肽及LDH呈正相关（r_S=0.604、0.596和0.631，均P <0.05），乳酸与cTnⅠ、脑钠肽及LDH呈正相关（r_S=0.748、0.666和0.738，均P <0.05）。NSE和乳酸在诊断心肌损伤严重程度时具有较高的敏感性［95.1%（95% CI：0.835，0.994）］和特异性［93.7%（95% CI：0.858，0.979）］。结论 NSE和乳酸可作为评估新生儿窒息后心肌损伤严重程度的有效生物标志物，有助于临床医师在早期进行风险评估和制订合适的治疗策略。

Abstract:

Objective To investigate the application value of neuron-specific enolase (NSE) and lactate levels in assessing the severity of myocardial injury following neonatal asphyxia.Method A retrospective analysis was conducted on 120 neonates with asphyxia and associated myocardial injury treated at Changzhou Maternal and Child Health Care Hospital from October 2020 to October 2023. Based on the levels of cardiac troponin I (cTnI), a myocardial injury biomarker, patients were divided into a mild group (79 cases) and a severe group (41 cases). Additionally, 60 healthy neonates born during the same period served as the control group. Serum levels of NSE, lactate, brain natriuretic peptide, and lactate dehydrogenase were compared among the three groups. Spearman's correlation analysis was used to examine the relationship between serum NSE, lactate, and myocardial injury markers. Receiver operating characteristic (ROC) curves were drawn to analyze the diagnostic value of these indicators in assessing the severity of myocardial injury in neonates with asphyxia.Result The levels of NSE and lactate were higher in the severe group compared to the mild and control groups (P <0.05), and also higher in the mild group compared to the control group (P <0.05). NSE showed positive correlations with cTnI, brain natriuretic peptide, and lactate dehydrogenase (r_s = 0.604, 0.596, and 0.631, respectively, all P <0.05). Lactate also showed positive correlations with these myocardial injury markers (r_s = 0.748, 0.666, and 0.738, respectively, all P <0.05). NSE and lactate demonstrated high sensitivity [95.1% (95% CI: 0.835, 0.994)] and specificity [93.7% (95% CI: 0.858, 0.979)] in diagnosing the severity of myocardial injury.Conclusion NSE and lactate can serve as effective biomarkers for assessing the severity of myocardial injury following neonatal asphyxia, aiding clinicians in early risk assessment and in devising appropriate treatment strategies.