CAJ | 학술논문

目的探讨脑白质损伤(PVL)早产儿血清 S100B及髓鞘碱性蛋白(MBP)水平的变化及其与预后判定的关系。方法选择2010年7月1日至2012年12月31日于暨南大学附属顺德妇幼保健院新生儿科住院的出生胎龄<34孕周的121例早产儿为研究对象,并根据头颅超声检查及 MRI 检查结果,将结果提示有PVL表现的78例早产儿纳入PVL组,将结果未见明显异常的43例早产儿纳入正常组。两组早产儿一般情况比较,差异无统计学意义(P>0.05)。所有患儿出院后每3个月随访1次,并采用《Gesell量表》测定患儿运动及智力发育商直至患儿纠正胎龄达1岁。根据早产儿生后第7天的血清 MBP (>10.0μg/L)及 S100B(>4.5μg/L)水平,再将其分为1组(正常早产儿)、2组(血清 S100B和 MBP 水平明显下降的PVL早产儿)及3组(血清 MBP和 S100B持续升高的PVL早产儿)。本研究遵循的程序符合暨南大学附属顺德妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书。结果①PVL 组早产儿血清 S100B水平在生后第3天开始升高,至生后第7天达最高峰,均显著高于正常组早产儿,两组比较,差异有统计学意义(P<0.05)；其血清S100B水平在生后第14天时降至最低,两组比较,差异无统计学意义(P>0.05)。②PVL组早产儿血清MBP水平在生后第3天达到峰值,此后逐渐下降,且其生后第1,3,7,14天的血清MBP水平均显著高于正常组早产儿,两组比较,差异均有统计学意义(P<0.05)。③随访结果显示,3组早产儿1岁时运动和智力发育商较1组和2组早产儿显著降低,前者与后二者比较,差异均有统计学意义(P<0.05)。结论 PVL患儿的血清MBP及S100B水平与其病情严重程度相关。患儿血清MBP及S100B水平持续升高超过7 d,则提示其预后不良。
목적탐토뇌백질손상(PVL)조산인혈청 S100B급수초감성단백(MBP)수평적변화급기여예후판정적관계。방법선택2010년7월1일지2012년12월31일우기남대학부속순덕부유보건원신생인과주원적출생태령<34잉주적121례조산인위연구대상,병근거두로초성검사급 MRI 검사결과,장결과제시유PVL표현적78례조산인납입PVL조,장결과미견명현이상적43례조산인납입정상조。량조조산인일반정황비교,차이무통계학의의(P>0.05)。소유환인출원후매3개월수방1차,병채용《Gesell량표》측정환인운동급지력발육상직지환인규정태령체1세。근거조산인생후제7천적혈청 MBP (>10.0μg/L)급 S100B(>4.5μg/L)수평,재장기분위1조(정상조산인)、2조(혈청 S100B화 MBP 수평명현하강적PVL조산인)급3조(혈청 MBP화 S100B지속승고적PVL조산인)。본연구준순적정서부합기남대학부속순덕부유보건원인체시험위원회소제정적윤리학표준,득도해위원회비준,분조정득수시대상감호인적지정동의,병여지첨서림상연구지정동의서。결과①PVL 조조산인혈청 S100B수평재생후제3천개시승고,지생후제7천체최고봉,균현저고우정상조조산인,량조비교,차이유통계학의의(P<0.05)；기혈청S100B수평재생후제14천시강지최저,량조비교,차이무통계학의의(P>0.05)。②PVL조조산인혈청MBP수평재생후제3천체도봉치,차후축점하강,차기생후제1,3,7,14천적혈청MBP수평균현저고우정상조조산인,량조비교,차이균유통계학의의(P<0.05)。③수방결과현시,3조조산인1세시운동화지력발육상교1조화2조조산인현저강저,전자여후이자비교,차이균유통계학의의(P<0.05)。결론 PVL환인적혈청MBP급S100B수평여기병정엄중정도상관。환인혈청MBP급S100B수평지속승고초과7 d,칙제시기예후불량。
Objective To investigate the changes of serum S100B and myelin basic protein (MBP)in premature infants with periventricular leukomalacia (PVL ) and their reliability in predicting outcome. Methods From 1st July 2010 to 31st December 2012,a total of 121 premature infants who were hospitalized in Maternal and Child Health Hospital,Jinan University were enrolled in the study.They were divided into PVL group(78 cases)and normal group (43 cases)according to their results of ultrasound and MRI.Serum MBP and S100B levels on the 1st day,3rd day,7th day and 14th day after birth were detected. Developmental quotients (DQ)were measured using Gesell development schedules until their correted gestational age reached 1 year old.They were also divided into group 1(normal premature infants),group 2 (PVL infants with decreased serum S100B and MBP level)and group 3(PVL infants with increased serum S100B and MBP level)according to their lab results at the 7th day after birth.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Maternal and Child Health Hospital of Jinan University. Informed consent was obtained from each participants′ parents. Results ①The serum S100B concentration of infants in PVL group were obviously higher than those of normal group at the 1st day,3rd day,7th day after birth.And no significant difference was found at the 14th day after birth between two groups.②The serum MBP concentration of infants in PVL group were significantly higher than those of normal group at the 1st day,3rd day,7th day and 14th day after birth.③ Infants whose serum MBP and S100B levels increased at the 7th day after birth had poor outcomes. Conclusions The serum MBP and S100B levels are correlated with severity of central nervous system injury.The increases in serum S100B and MBP at the 7th day after birth are associated with poor outcomes.