| 王红坡,闫瑞芳,韩东明,等.磁敏感加权成像联合血清脑源性神经营养因子、水通道蛋白 -4检测对新生儿窒息早期脑损伤的诊断价值[J].安徽医药,2021,25(7):1343-1346. |
| 磁敏感加权成像联合血清脑源性神经营养因子、水通道蛋白 -4检测对新生儿窒息早期脑损伤的诊断价值 |
| Diagnostic value of susceptibility weighted imaging combined with serum brain-derived neu? rotrophic factor and aquaporin-4 in early brain injury of neonatal asphyxia |
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| DOI：10.3969/j.issn.1009-6469.2021.07.017 |
| 中文关键词: 新生儿窒息 缺氧缺血，脑 磁敏感加权成像 血清 脑源性神经营养因子 水通道蛋白 -4 诊断价值 |
| 英文关键词: Asphyxia neonatorum Hypoxia-ischemia,brain Susceptibility weighted imaging Serum Brain-derived neurotrophic factor Aquaporin-4 Diagnostic value |
| 基金项目:河南省医学科技攻关计划项目( 201602151) |
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| 中文摘要: |
| 目的对新生儿窒息脑损伤病人进行磁敏感加权成像( SWI)检查，并检测血清脑源性神经营养因子( BDNF)、水通道蛋白 -4(AQP-4)水平，评估联合检查对新生儿窒息脑损伤的诊断价值。方法选取 2017年 5月至 2019年 5月在新乡医学院第一附属医院出生的新生儿窒息脑损伤病人(观察组) 123例作为研究对象，同期出生的健康新生儿(对照组) 125例作为对照。对两组新生儿进行 SWI检查；采集两组新生儿清晨外周血提取血清，利用酶联免疫吸附法( ELISA)检测血清中 BDNF、AQP-4表达水平；采用四格表分析评估 SWI检查对新生儿窒息脑损伤的诊断价值；采用受试者工作特征( ROC)曲线评估血清 BDNF、 AQP-4表达水平对新生儿窒息脑损伤的诊断价值。结果观察组采用 SWI检查的患病检出率( 86.2%)、血清 AQP-4水平(148.73±48.74)ng/mL高于对照组［( 35.2%)、(98.56±30.93)ng/mL］(P<0.05)；血清 BDNF水平( 1.35±0.30)ng/mL明显低于对照组( 1.79±0.54)ng/mL(P<0.05)。 SWI检测新生儿窒息脑损伤的灵敏度为 86.2%，特异性为 64.8%，准确度为 75.4%；BDNF灵敏度为 86.2%，特异性为 64.0%，准确度为 75.0%；AQP-4灵敏度为 75.6%，特异性为 75.2%，准确度为 75.4%。SWI联合血清 BDNF、AQP-4水平检测新生儿窒息脑损伤的灵敏度为 95.1%，特异性为 89.6%，准确度为 92.3%，误诊率为 10.4%，漏诊率为 4.9%，约登指数为 84.7%，阳性预测值为 90.0%，阴性预测值为 94.9%；与单独检测相比，三者联合检测诊断新生儿窒息脑损伤的灵敏度、特异性和准确度均明显升高( P<0.05)。结论新生儿窒息脑损伤病人采用 SWI检查的患病检出率高于健康对照组，血清 AQP-4水平明显升高，血清 BDNF水平明显降低， SWI检查、血清 BDNF、AQP-4水平对新生儿窒息脑损伤均有一定诊断价值，三者联合检测对新生儿窒息脑损伤的诊断价值更高，可用于临床借鉴。 |
| 英文摘要: |
| Objective To perform magnetic susceptibility weighted imaging (SWI) in neonatal asphyxia patients with brain injury,and detect the levels of brain-derived neurotrophic factor (BDNF) and aquaporin-4 (AQP-4) in serum, and evaluate the diagnostic value of SWI combined with levels of serum BDNF and AQP-4 in neonatal asphyxia brain injury.Methods 123 neonatal asphyxia patientswith brain injury patients (observation group) born in The First Affiliated Hospital of Xinxiang Medical College from May 2017 to May2019 were selected as the study subjects, and 125 healthy neonates (control group) born in the same period were selected as the controlgroup. The newborns of two groups underwent SWI examination; serum was collected from peripheral blood of two groups of newbornsin the morning, the expression levels of BDNF and AQP-4 in serum were detected by enzyme-linked immunosorbent assay (ELISA); four-table analysis was used to evaluate the diagnostic value of SWI in neonatal asphyxia brain injury; the diagnostic values of levels ofserum BDNF and AQP-4 in neonatal asphyxia brain injury were evaluated by receiver operating characteristic (ROC) curve.Results The prevalence of disease by SWI (86.2%) and serum AQP-4 level (148.73±48.74) ng/mL in the observation group were higher than those in the control group [(35.2%) , (98.56±30.93) ng/mL] (P < 0.05); and the serum BDNF level (1.35±0.30) ng/mL was lower than that in the control group (1.79±0.54) ng/mL(P < 0.05). The sensitivity of SWI for neonatal asphyxia patients with brain injury was86.2%, the specificity was 64.8%, the accuracy was 75.4%,BDNF was 86.2%, the specificity was 64.0%, the accuracy was 75.0%,AQP4 was 75.6%, specificity was 75.2%, accuracy was 75.4%. The sensitivity of SWI combined with levels of serum BDNF and AQP-4 for neonatal asphyxia brain injury was 95.1%, the specificity was 89.6%, the accuracy was 92.3%, the misdiagnosis rate was 10.4%, therate of missed diagnosis was 4.9%, the Yoden index was 84.7%, the positive predictive value was 90.0%, and the negative predictive value was 94.9%. Compared with the single tests, the sensitivity, specificity and accuracy of the three combined test in the diagnosis ofneonatal asphyxia brain injury were significantly higher (P < 0.05).Conclusions The prevalence of neonatal asphyxia brain injury by SWI is higher than that of healthy control group, the serum AQP-4 level is significantly higher and the serum BDNF level is significantly lower. SWI, serum BDNF and AQP-4 levels have certain diagnostic value for neonatal asphyxia brain injury. The combined detectionof them has higher diagnostic value for neonatal asphyxia brain injury and can be used for clinical reference. |
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