本文選題：缺氧缺血性腦病 + N末端B型鈉尿肽原�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的探討臍帶血血清N末端B型鈉尿肽原(NT-pro BNP)及心肌酶在新生兒缺氧缺血性腦病(HIE)中的變化,評(píng)估其對新生兒HIE臨床診斷的預(yù)測價(jià)值。方法選取足月、無圍產(chǎn)期窒息高危因素和生后窒息史的健康新生兒20例作為對照組;將胎齡為(37-42)周,有圍產(chǎn)期窒息高危因素的60例新生兒作為觀察組,根據(jù)是否發(fā)生HIE及HIE的病情分度分為非HIE組(6例)、輕度HIE組(10例)、中度HIE組(36例)和重度HIE組(8例)。分別觀察兩組新生兒的臨床資料、心電圖、心臟超聲的結(jié)果;于分娩后立即抽取臍靜脈血4ml,分別檢測臍帶血清NT-pro BNP、心肌酶水平,計(jì)算臍帶血血清NT-pro BNP和心肌酶診斷HIE的診斷價(jià)值。結(jié)果兩組患兒性別、胎齡、體重、身長、分娩方式差別無統(tǒng)計(jì)學(xué)意義(P0.05)。具有窒息高危因素的觀察組HIE發(fā)生率高于對照組,差異有統(tǒng)計(jì)學(xué)意義(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組及對照組,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組血清NT-pro BNP水平明顯高于對照組(P0.05)。HIE組心肌酶(CK-MB、CK、LDH、AST)水平明顯高于非HIE組及對照組(P0.05),非HIE組及對照組CK-MB結(jié)果無明顯差異(P0.05)。HIE組血清NT-pro BNP與CK-MB水平呈正相關(guān)(r=0.537,P0.05),二者水平與HIE組病情嚴(yán)重程度呈正相關(guān)(r1=0.608,r2=0.438,P均0.05)。血清NT-pro BNP水平診斷HIE的ROC曲線下面積為0.954,最佳診斷界點(diǎn)1034.83 pg/ml。血清CK-MB水平診斷HIE的ROC曲線下面積為0.925,最佳診斷界點(diǎn)42.99 U/L。二者聯(lián)合檢測診斷HIE的ROC曲線下面積為0.979,特異度為88.5%,靈敏度為96.3%,聯(lián)合檢測診斷價(jià)值優(yōu)于CK-MB單獨(dú)檢測,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),與NT-pro BNP相比無明顯差異(P0.05)。結(jié)論HIE組新生兒臍帶血血清NT-pro BNP、CK-MB水平有不同程度的升高;臍帶血血清NT-pro BNP、CK-MB水平可以早期反映HIE病情嚴(yán)重程度;早期聯(lián)合檢測臍帶血血清NT-pro BNP、CK-MB可以早期預(yù)測HIE的發(fā)生和有效評(píng)估其嚴(yán)重程度,為早期干預(yù)提供理論依據(jù)。
[Abstract]:Objective to investigate the changes of serum N-terminal B-type natriuretic peptide (NT-pro BNPs) and myocardial enzymes in neonates with hypoxic-ischemic encephalopathy (HIE) and to evaluate the predictive value of NT-pro BNPs in clinical diagnosis of neonatal HIE. Methods A total of 20 healthy neonates without perinatal asphyxia risk factors and postnatal asphyxia history were selected as control group, and 60 neonates with perinatal asphyxia risk factors at gestational age of 37-42 weeks were selected as observation group. According to the severity of HIE and HIE, the patients were divided into non-HIE group (n = 6), mild HIE group (n = 10), moderate HIE group (n = 36) and severe HIE group (n = 8). The clinical data, electrocardiogram (ECG) and the results of cardiac ultrasound were observed, and the umbilical vein blood (4 ml) was extracted immediately after delivery, and the levels of NT-pro BNPand myocardial enzyme in cord blood were measured. The diagnostic value of serum NT-pro BNP and myocardial enzyme in diagnosing HIE was calculated. Results there was no significant difference in sex, gestational age, body weight, body length and delivery mode between the two groups (P 0.05). The incidence of HIE in the observation group with high risk factors of asphyxia was higher than that in the control group, and the difference was statistically significant (P 0.05). The incidence of abnormal ECG and echocardiography in the observation group was significantly higher than that in the non-HIE group and the control group, and the difference was statistically significant (P 0.05). The serum NT-pro BNP level in the observation group was significantly higher than that in the control group (P 0.05). The level of serum NT-pro BNP in the observation group was significantly higher than that in the non-HIE group and the control group (P 0.05). There was no significant difference in the results of CK-MB between the non-HIE group and the control group. There was a positive correlation between the serum NT-pro BNP level and the CK-MB level in the non-HIE group and the control group. There was a positive correlation between the serum NT-pro BNP level and the CK-MB level. There was a positive correlation between the severity of the disease and the severity of the disease in the HIE group. The area under the ROC curve of serum NT-pro BNP level for HIE diagnosis was 0.954, and the best diagnostic threshold was 1034.83 PG / ml. The area under the ROC curve of serum CK-MB level for HIE diagnosis was 0.925, and the best diagnostic threshold was 42.99 U / L. The area under the ROC curve was 0.979, the specificity was 88.5and the sensitivity was 96.3.The diagnostic value of the combined detection was better than that of CK-MB alone, and the difference was statistically significant (P 0.05), but there was no significant difference compared with NT-pro BNP (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 serum of cord blood can reflect the severity of HIE in early stage. Early combined detection of serum NT-pro BNPK-MB in cord blood can predict the occurrence of HIE and evaluate its severity effectively, and provide theoretical basis for early intervention.
【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 郭思聰;劉興利;賈晨紅;張新忠;萬繼業(yè);李曉東;;NT-proBNP與急性冠脈綜合征患者冠脈病變程度及預(yù)后的關(guān)系[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2016年33期

2 魯旭;姜泓;張淵韜;;新生兒缺氧缺血性腦病發(fā)病機(jī)制研究進(jìn)展[J];新鄉(xiāng)醫(yī)學(xué)院學(xué)報(bào);2016年10期

3 楊愛香;;早期不同時(shí)間窗干預(yù)對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

4 宦鵬;黃靜;杜雪梅;趙波;吳家富;王芬;;心肌酶譜在新生兒缺氧缺血性腦病及分度中的臨床意義[J];西部醫(yī)學(xué);2016年09期

5 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

6 孫艷蘭;張瑞瑞;張慕玲;;足月兒與早產(chǎn)兒血清CK-MB、MYO、BNP、cTnI水平變化及其臨床意義[J];中國婦幼健康研究;2016年07期

7 萬改紅;孫桂云;;血漿N端腦鈉肽對新生兒窒息后心力衰竭的早期診斷的臨床價(jià)值[J];甘肅科技縱橫;2016年03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 劉曉麗;陳婷;林麗星;;新生兒窒息合并心肌損傷生化標(biāo)志物臨床應(yīng)用研究進(jìn)展[J];兒科藥學(xué)雜志;2015年12期

10 陳莉農(nóng);羅君;郭奇;戴澤蘭;劉成桂;;心肌損傷標(biāo)志物檢測在新生兒缺氧缺血性腦病嚴(yán)重程度評(píng)估中的應(yīng)用價(jià)值[J];中國當(dāng)代醫(yī)藥;2015年24期

相關(guān)碩士學(xué)位論文 前1條

1 王家蓉;新生兒缺氧缺血性腦病高壓氧治療療效及血中NSE、MDA的變化[D];重慶醫(yī)科大學(xué);2004年

，

本文編號(hào)：1899757