本文選題：新生兒缺氧缺血性腦病　切入點(diǎn)：心肌肌鈣蛋白I　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的通過聯(lián)合檢測(cè)新生兒臍帶血血清肌鈣蛋白I(cardiac troponin I,cTnI)、肌紅蛋白(myoglobin,Mb)、心肌型肌酸激酶同工酶(MB fraction of creatine kinase,CK-MB)在新生兒缺氧缺血性腦病(hypoxic ischemic encephalo-pathy,HIE)水平變化,探討其在新生兒HIE中的臨床應(yīng)用價(jià)值。方法2016年01月~2016年12月間在金鄉(xiāng)人民醫(yī)院產(chǎn)科分娩,具有圍產(chǎn)期窒息高危因素,可能發(fā)生HIE的60例足月單胎新生兒作為觀察組,同時(shí)選取足月無圍產(chǎn)期窒息高危因素的健康單胎新生兒20例作為對(duì)照組。隨診發(fā)現(xiàn)觀察組中患新生兒HIE的54例,設(shè)為HIE組,其中輕中重組分別有10、36、8例。未患HIE的設(shè)為非HIE組,共6例。新生兒娩出后立即抽取臍靜脈血4ml。采用化學(xué)發(fā)光法檢測(cè)血清cTnI、Mb,免疫抑制法檢測(cè)CK-MB水平,分析不同指標(biāo)預(yù)測(cè)HIE及其心肌損傷的臨床價(jià)值。結(jié)果各組新生兒性別、胎齡、體重、身長(zhǎng)、分娩方式無差異(P0.05)。HIE組心血管表現(xiàn)、心電圖及心臟超聲異常的發(fā)生率明顯高于非HIE組及對(duì)照組(P0.05)。中重度HIE組臍帶血血清cTnI、Mb水平明顯高于輕度組、非HIE組和對(duì)照組(P0.05),輕度組與非HIE組、對(duì)照組比較差異無統(tǒng)計(jì)學(xué)意義。中重度HIE組臍帶血血清CK-MB水平明顯高于輕度組、非HIE組和對(duì)照組(P0.05),輕度HIE組CK-MB水平明顯高于非HIE組和對(duì)照組(P0.05)。臍帶血血清cTnI、Mb和CK-MB三個(gè)指標(biāo)之間及三個(gè)指標(biāo)與HIE組病情嚴(yán)重程度呈正相關(guān)(相關(guān)系數(shù)均0且P值均0.05)。臍帶血血清cTnI、Mb、CK-MB診斷HIE的ROC曲線下面積分別為0.896、0.932、0.925,最佳診斷界點(diǎn)分別為0.0157ng/ml、96.53 ng/ml、43.0U/L。臍帶血血清cTnI、Mb、CK-MB和聯(lián)合診斷模型PRE之間AUC兩兩比較,cTnI、Mb、CK-MB三者之間無統(tǒng)計(jì)學(xué)意義(P0.05),cTnI、Mb、CK-MB三者分別與PRE比較有統(tǒng)計(jì)學(xué)意義(P0.05)。臍帶血血清cTnI、Mb、CK-MB診斷HIE心肌損傷的ROC曲線下面積分別為0.767、0.679、0.798,最佳診斷界點(diǎn)分別為0.0159ng/ml、161.47 ng/ml、81.48U/L。cTnI、Mb、CK-MB和聯(lián)合診斷模型PRE之間AUC兩兩比較,cTnI、Mb、CK-MB之間無統(tǒng)計(jì)學(xué)意義(P0.05),cTnI、CK-MB與PRE無統(tǒng)計(jì)學(xué)意義(P0.05),Mb與PRE比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論HIE組新生兒臍帶血血清cTnI、Mb、CK-MB水平有不同程度的升高,臍帶血血清cTnI、Mb、CK-MB水平可早期反映HIE病情嚴(yán)重程度;早期聯(lián)合檢測(cè)臍帶血血清cTnI、Mb、CK-MB可早期預(yù)測(cè)HIE的發(fā)生、有效評(píng)估其嚴(yán)重程度,為早期干預(yù)、改善預(yù)后提供理論依據(jù);早期檢測(cè)臍帶血血清cTnI、CK-MB可以早期預(yù)測(cè)HIE心肌損傷的發(fā)生。
[Abstract]:Objective to detect the changes of serum I(cardiac troponin troponin cTnI, myoglobin myoglobin MbP, myocardial creatine kinase isoenzyme MB fraction of creatine kinases CK-MBs in neonates with hypoxic ischemic encephalopathy (HIE) by means of combined detection of the levels of I(cardiac troponin IcTnI, myoglobin myoglobinine (MB) and myocardial creatine kinase isoenzyme (MB fraction of creatine kinases) in neonates with hypoxic-ischemic encephalopathy (HIE).To explore the clinical application value of HIE in neonates.Methods from January 2016 to December 2016, 60 neonates with term single fetus who had perinatal asphyxia risk factors in Jinxiang people's Hospital were used as observation group.At the same time, 20 healthy singleton neonates without perinatal asphyxia risk factors were selected as control group.54 cases of neonatal HIE in the observation group were divided into HIE group, including 1036 cases of mild moderate recombination.The patients without HIE were divided into non-HIE group (n = 6).Umbilical vein blood was extracted immediately after delivery.Serum cTnI Mb was detected by chemiluminescence assay and CK-MB level was detected by immunosuppressive method. The clinical value of different indexes in predicting HIE and myocardial injury was analyzed.Results there was no significant difference in sex, gestational age, body weight, body length and delivery pattern between the groups. The incidence of abnormal ECG and echocardiography in the group of HIE was significantly higher than that in the group without HIE and the control group (P 0.05).The level of cTnI Mb in cord blood of moderate and severe HIE group was significantly higher than that of mild group, non-#en1# group and control group (P0.05). There was no significant difference between mild group and non-#en2# group.The level of serum CK-MB in moderate and severe HIE group was significantly higher than that in mild group. The level of CK-MB in mild HIE group was significantly higher than that in non-#en5# group and control group (P0.05).Serum cTnIb and CK-MB were positively correlated with the severity of HIE (correlation coefficient 0 and P = 0.05).The area under the ROC curve of cord blood serum cTnI MbCK-MB for the diagnosis of HIE was 0.8960.932 鹵0.925, and the best diagnostic threshold was 0.0157ng / ml 96.53ng / ml ~ (43.0) U / L, respectively.Comparison of AUC between CK-MB in cord blood serum cTnI and AUC in combined diagnostic model MbCK-MB there was no significant difference among CK-MB and CK-MB of cTnInCK-MB. There was significant difference between CK-MB of cTnI and MbCK-MB compared with that of PRE (P 0.05).The difference of PRE was statistically significant (P 0.05).Conclusion the level of CK-MB in umbilical cord blood of neonates in HIE group is increased in varying degrees, and the level of CK-MB in cord blood can reflect the severity of HIE at an early stage, and the early detection of CT-MB in cord blood can predict the occurrence of HIE and evaluate its severity.Early detection of serum cTnIK-MB in umbilical cord blood can early predict the occurrence of myocardial injury in HIE.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 趙友誼;張曉蘭;丁敏;盧林陽;蘆瑋瑋;;循證護(hù)理干預(yù)對(duì)新生兒缺氧缺血性腦病智能發(fā)育的影響[J];檢驗(yàn)醫(yī)學(xué)與臨床;2017年06期

2 陳劍;;新生兒缺氧缺血性腦病發(fā)病危險(xiǎn)因素病例對(duì)照研究[J];中國(guó)婦幼保健;2017年04期

3 魏麗夏;任青;趙淑云;張勇軍;;亞低溫和川芎嗪對(duì)新生兒缺氧缺血性腦病的保護(hù)作用[J];兒科藥學(xué)雜志;2016年10期

4 楊愛香;;早期不同時(shí)間窗干預(yù)對(duì)新生兒缺氧缺血性腦病預(yù)后影響的研究[J];河北醫(yī)學(xué);2016年09期

5 孫耀輝;;CT和MRI對(duì)新生兒缺血缺氧性腦病的診斷價(jià)值比較[J];臨床醫(yī)學(xué)研究與實(shí)踐;2016年15期

6 黃海川;;新生兒缺氧缺血性腦病危險(xiǎn)因素的臨床研究[J];現(xiàn)代診斷與治療;2016年15期

7 章櫻;陳國(guó)慶;張勤;;磷酸肌酸鈉對(duì)新生兒缺氧缺血性腦病氧化應(yīng)激的影響及心肌損傷的保護(hù)作用[J];中華全科醫(yī)學(xué);2016年05期

8 黃維清;彭小明;顏衛(wèi)群;肖勇;張帆;;新生兒缺氧缺血性腦病發(fā)病及預(yù)后影響因素分析[J];人民軍醫(yī);2016年02期

9 陳北洋;;TNF-α和IL-1β對(duì)新生兒缺血缺氧性腦病的臨床診斷價(jià)值[J];中國(guó)現(xiàn)代醫(yī)生;2015年34期

10 盧雨欣;江雯;林艷;鐘劍峰;;血清tau蛋白水平與新生兒缺血缺氧性腦病的嚴(yán)重程度并與神經(jīng)發(fā)育預(yù)后相關(guān)研究[J];中國(guó)兒童保健雜志;2015年11期

，

本文編號(hào)：1725518