陈莉农等

[摘要] 目的 探讨心肌损伤标志物检测在新生儿缺氧缺血性脑病（HIE）严重程度评估中的价值。 方法 采用病例-对照研究，选取本院2014年5～10月的271例HIE患儿，根据新生儿HIE诊断标准分为重度72例、中度86例、轻度113例，并以同期120例健康新生儿作为健康对照组，用全自动化学发光免疫分析法动态检测各组血清心肌肌钙蛋白I（cTnI）、肌红蛋白（Myo）和肌酸激酶同工酶（CK-MB）浓度，统计分析心肌损伤标志物变化与脑损伤的关系。 结果 患病12～24 h，cTnI以重度HIE组最高，为（1.56±1.33）μg/L；中度、轻度HIE组次之，分别为（0.63±0.47）、（0.26±0.17）μg/L，均明显高于健康对照组 [（0.06±0.05）μg/L] （F=97.64，P<0.01）。271例HIE患儿心肌损伤发生率为40.96%，其中重度HIE组为87.50%，中度HIE组为46.51%，轻度HIE组为7.08%，3组比较差异有统计学意义（χ2=119.22，P<0.01）。患病12 h内，重度、中度、轻度HIE组3种心肌损伤标志物均以Myo异常率最高；患病12～24 h，HIE各组cTnI、Myo、CK-MB异常率基本一致；患病2 d后，HIE各组Myo异常率均持续下降，cTnI和CK-MB异常率却维持在较高水平达5～8 d。 结论 HIE患儿心肌损伤与脑损伤紧密相联——脑损伤越重，心肌损伤也越重；检测心肌损伤标志物有助于HIE严重程度的评估。

[关键词] 新生儿缺氧缺血性脑病；心肌肌钙蛋白I；肌红蛋白；肌酸激酶同工酶

[中图分类号] R722.1 [文献标识码] A [文章编号] 1674-4721（2015）08（c）-0132-04

[Abstract] Objective To investigate the value of myocardial damage markers in the severity assessment of hypoxic ischemic encephalopathy （HIE） in neonates. Methods Case-control study was used，and 271 cases with HIE from May to October 2014 in our hospital were selected.According to the diagnostic criteria for HIE in neonates，the patients were divided into severe ones （72 cases），moderate ones （86 cases） and mild ones （113 cases）.120 healthy neonates were selected as healthy control group at the same time.The concentration of serum cardiac troponin I （cTnI），myoglobin （Myo） and creatine kinase isoenzyme MB mass （CK-MB） were dynamically detected by fully automatic chemiluminescence immunoassay.The relationship between the change of myocardial damage marker and brain damage was statistically analyzed. Results When sick for 12 to 24 hours，the concentration of three HIE groups were higher when compared with healthy control group [（0.06±0.05） μg/L].The concentration of cTnI was the highest in severe HIE group [（1.56±1.33） μg/L]，the secondly higher in moderate HIE group [（0.63±0.47） μg/L] and the thirdly higher in mild HIE group [（0.26±0.17） μg/L] （F=97.64，P<0.01）.The incidence rate of HIE myocardial damage was 40.96%.Among them，the percentage in severe HIE group was 87.50%，in moderate HIE group was 46.51% and in mild HIE group was 7.08%，and there was significant difference among them （χ2=119.22，P<0.01）.When sick less than 12 hours，abnormal rate of Myo was the highest in the three kinds of myocardial damage markers in the severe，moderate and mild HIE group.When sick for 12 to 24 hours，abnormal rate of cTnI，Myo and CK-MB in three HIE groups were basically consistent.When sick more than 2 days，abnormal rate of Myo in three HIE groups continued to decrease.And the abnormal rates of cTnI and CK-MB were maintained at a higher level for 5 to 8 days. Conclusion There is a close association between myocardial damage in neonates with HIE and brain damage—the more serious the brain damage of HIE newborns，the more serious the myocardial damage is.The detection of myocardial damage marker is helpful to the assessment of the HIE severity.

[Key words] Hypoxic ischemic encephalopathy in neonates；Cardiac troponin I；Myoglobin；Creatine kinase isoenzyme MB

新生儿缺氧缺血性脑病（hypoxic ischemic encephalopathy，HIE）是指围生期窒息导致脑的缺氧缺血性损害，临床可分重、中、轻度，脑组织以水肿、软化、坏死和出血为主要病变，临床主要表现为意识障碍、脑水肿、惊厥、肌张力变化、原始反射异常等一系列中枢神经系统的异常[1]。围生期窒息是本症的主要病因，缺氧缺血是本症的重要本质[2]，缺氧不仅可导致新生儿脑损伤，而且因呼吸循环功能不良，可引起心肌功能障碍[3-4]。为探讨HIE心肌损伤与脑损伤的关系，本研究检测了72例重度HIE、86例中度HIE、113例轻度HIE患儿血清心肌肌钙蛋白I（cTnI）、肌红蛋白（Myo）和肌酸激酶同工酶（CK-MB）3种心肌损伤标志物的浓度，并以120例健康新生儿作为对照，现报道如下。

1 资料与方法

1.1 一般资料

选取2014年5～10月在本院住院的HIE患儿271例，根据新生儿缺氧缺血性脑病诊断标准[5]，诊断重度72例（61例痊愈、8例好转、3例死亡），中度86例（83例痊愈、3例好转），轻度113例（全部痊愈）；……