摘要
目的 探讨彩色多普勒超声联合血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)及5 min Apgar评分对新生儿颅内出血(intracranial hemorrhage,ICH)的诊断价值及影响ICH发生的危险因素.方法 选取2019年2月至2021年3月承德市中心医院新生儿科收治的存在颅脑损伤危险因素的253例新生儿为研究对象,均接受彩色多普勒超声检查,根据是否存在ICH分为ICH组(n=99)和无ICH组(n=154).观察并比较两组彩色多普勒超声参数[收缩期峰值流速(peak systolic velocity,PSV)、阻力指数(resistance index,RI)、舒张末期流速(end diastolic velocity,EDV)]、血清 NSE水平、5 min Apgar评分情况,分析血清NSE水平、Apgar评分与彩色多普勒超声参数的相关性及三者联合检测对新生儿ICH的诊断价值,并分析ICH发生的主要影响因素.统计学方法采用独立样本t检验、x2检验、Pearson相关性分析、Logistic回归分析及受试者操作特征(receiver operating characteristic,ROC)曲线分析.结果 ICH 组与无 ICH 组 PSV[(6.4±1.2)cm/s 与(10.1±1.4)cm/s,t=21.628]、RI(0.6±0.1 与 0.7±0.1,t=8.144)、EDV[(2.5±0.4)cm/s 与(3.1±0.4)cm/s,t=13.216]以及 5 min Apgar 评分[(6.5±1.7)分与(8.8±1.0)分,t=13.308]比较,ICH组均显著低于无ICH组(P值均＜0.001);血清NSE 水平显著高于无 1CH组[(149.1±10.6)μg/L 与(95.2±10.4)μg/L,t=40.015,P＜0.001].ICH 组血清NSE水平与彩色多普勒超声参数PSV、RI、EDV呈负相关(r值分别为-0.573、-0.520、-0.536,P值均＜0.05);5 min Apgar评分与彩色多普勒超声参数PSV、RI、EDV呈正相关(r值分别为0.601、0.529、0.505,P值均＜0.05).ROC曲线结果发现,彩色多普勒超声、血清NSE水平、5 min Apgar评分联合诊断新生儿ICH的曲线下面积(area under the curve,AUC)最大,为0.861.单因素分析显示,与无ICH组比较,ICH组患儿的胎龄更小,出生体质量、5 min Apgar评分更低,出生窒息、应用多巴胺、应用机械通气比例及血清NSE水平更高,差异有统计学意义(P值均＜0.05).多因素Logistic回归分析结果显示,胎龄＜32周、出生体质量＜1 500 g、血清NSE水平＞117.95 μg/L、5 min Apgar评分＜7分是诱发ICH的独立危险因素.结论 彩色多普勒超声联合血清NSE及5 min Apgar评分可提高ICH的诊断价值;胎龄＜32周、出生体质量＜1 500 g、血清NSE水平＞117.95 μg/L、5 min Apgar评分＜7分是诱发ICH的独立危险因素.
Abstract
Objective To investigate the diagnostic value of color Doppler ultrasound combined with neuron-specific enolase(NSE)and 5 min Apgar score in neonatal intracranial hemorrhage(ICH)and risk factors affecting the occurrence of ICH.Method A total of 253 neonates who underwent color Doppler ultrasound examination to the Department of Neonatology,Chengde Central Hospital from February 2019 to March 2021 were enrolled as study subjects,and they were divided into ICH group(n=99)and non-ICH group(n=1 54)according to the presence or absence of ICH.The two sets of color Doppler ultrasound parameters[peak systolic velocity(PSV),resistance index(RI),end diastolic velocity(EDV)],serum NSE level,5 min Apgar score were observed and compared,and the correlation between of Apgar score,color Doppler ultrasound parameters and NSE level were analyzed.The diagnostic value of the combination of the three in neonatal ICH were analyzed,and the risk factors affecting the occurrence of ICH were analyzed.The statistical methods performed by independent sample t-test,x2 test,Pearson correlation analysis,Logistic regression analysis and receiver operating characteristic(ROC)curve analysis.Result PSV[(6.4±1.2)cm/s vs(10.1±1.4)cm/s,t=21.628]and RI(0.6±0.1 vs 0.7±0.1,t=8.144),EDV[(2.5±0.4)cm/s vs(3.1±0.4)cm/s,t=13.216]and 5 min Apgar score[(6.5±1.7)points vs(8.8±1.0)points,t=13.308]in ICH group were significantly lower than those in non-ICH group(all P＜0.05),and the serum NSE level was significantly higher than that of non-ICH group[(149.1±10.6)μg/L vs(95.2±10.4)μg/L,t=40.015,P＜0.00 1].The serum NSE levels in the ICH group were negatively correlated with the color Doppler ultrasound parameters PSV,RI and EDV(r=-0.573,-0.520,-0.536,all P＜0.05),and the 5 min Apgar score was positively correlated with the color Doppler ultrasound parameters PSV,RI and EDV(r=0.601,0.529,0.505,all P＜0.05).The results of the ROC curve showed that the area under the curve(AUC)of color doppler ultrasound,serum NSE and 5 min Apgar score combined to diagnose neonatal ICH was the largest,which was 0.861.Univariate analysis showed that children in the ICH group had a smaller gestational age,lower birth weight,lower 5 min Apgar score,higher proportion of birth apnea,dopamine,mechanical ventilation and serum NSE levels compared with the non-ICH group(all P＜0.05).Multivariate Logistic regression analysis showed that gestational age＜32 weeks,birth weight＜1 500 g,serum NSE level＞117.95 μg/L,and 5 min Apgar score＜7 points were independent risk factors for ICH.Conclusion Color Doppler ultrasound combined with serum NSE and 5 min Apgar score can improve the diagnostic value of ICH.Gestational age＜32 weeks,birth weight＜1 500 g,serum NSE level＞117.95 μg/L,and 5 min Apgar score＜7 points are independent risk factors for ICH.
基金项目
河北省科学技术研究与发展计划项目(202201A007)
万方数据