| Objective:In recent years,with the improvement of neonatal treatment capacity,the survival rate of premature infants has increased significantly;however,the incidence of brain injuryin premature infants(BIPI)has also increased,periventricular-intraventricular hemorrhage(PIVH)and periventricularleukinomalacia(PVL)were more common in clinical,if the treatment is not in time,it often causes cognitive deficiency in children,and even leads to the death of children,which brings a heavy burden to the society.BIPI has hidden its manifestations and lacked specificity in the early stage of its occurrence.At present,the diagnosis mainly relies on cranial ultrasound,MRI and other examinations,but there are some limitations.Knowing more about the mechanism of BIPI,it has been found that many serological markers are expressed in different degrees during the development of BIPI.Neurofilament light chain(NFL)is a type of nerve silk protein,which can maintain the form of neurons and the integrity of nerve fibers.a II spectrin breakdown products 145(SBDP145)is an important component of all spectrin,which is expressed in neurons largely and participates in vesicle transport and neurotransmitter release.By studying the relationship between serum NFL,SBDP145 and brain injury in premature infants,it aims at exploring the predictive value of serum NFL,SBDP145 on preterm brain injury,in order to provide new theoretical basis and diagnostic ideas for clinical practice.Methods:1.A total of 79 premature infants who were delivered in the department of obstetrics of our hospital from June 2019 to December 2020 and transferred to the neonatal department of our hospital within 24 hours after delivery were selected as the research subjects.All selected preterm infants with gestational age less than 34 weeks and daily age ranging from 0 to 24 hours,with the following conditions were excluded:(1)congenital or(and)genetic metabolic diseases;(2)other types of encephalopathy except PIVH and PVL;(3)obvious deformity of other system and nervve systems;(4)infectious diseases of nervous system;(5)early death or abandonment of treatment after birth.2.Two milliliters of venous blood were collected on the first day,third day and seventh day,and the levels of serum NFL and SBDP145 were detected by enzyme-linked immunosorbent assay(ELISA).The enrolled children were performed cranial ultrasonography 3 days after birth,followed by reexamination every 1-2 weeks until discharge.Correct the gestational age at 40 weeks or complete cranial MRI and other examinations at discharge.3.According to the results of cranial ultrasound and MRI,the enrolled children were divided into PIVH group,PVL group(those with PIVH combined with PVL were included in PVL group)and no brain injury group.4.This data is analyzed by SPSS24.0 statistical software,in which the measurement data are expressed by mean±standard deviation(`x±s).When the measurement data are in accordance with the normal distribution and the variance is uniform,the single factor analysis of variance is used for inter-group comparison,and the LSD-t test is used for further comparison between groups.When the variance is uneven,the corrected single-factor analysis of variance is used for inter-group comparison,and the further comparison between groups is used Gaimes-Howell test.Repeated measures analysis of variance were used for comparison at different time points within the same group.Enumeration data were expressed as the number of cases and percentage,and compared with the chi-square test.ROC curve was drawn to calculate sensitivity and specificity.AUC ≥ 0.7 was of diagnostic significance,while P<0.05 was of statistical significance.Results:1.On the 1st,3rd and 7th day after birth,the serum NFL level of PIVH group and PVL group was significantly higher than that of non-brain injury group,the differences were statistically significant(P<0.05),but there was no statistically significant difference in serum NFL level between PIVH group and PVL group(P>0.05);The serum NFL level of PIVH group and PVL group increased on the 3rd day after the 1st day,on the 7th day after the 1st day,respectively,with statistical significance(P<0.05).The serum NFL level of PIVH group and PVL group was not significantly changed on the 7th day after the 3rd day(P>0.05);There were no significant changes in serum NFL levels in the non-brain injury group on the 1st,3rd and 7th day(P>0.05).2.On the 1st,3rd and 7th day after birth,serum SBDP145 levels in PIVH and PVL groups were significantly higher than those in the group without brain injury(P<0.01),but there was no significant difference in serum SBDP145 levels between PIVH and PVL groups(P>0.05);Serum SBDP145 level in PIVH group and PVL group increased on the 3rd day after the 1st day,on the 7th day after the 1st day,and on the 7th day after the 3rd day,the difference was statistically significant(P<0.05).The serum SBDP145 level in the non-brain injury group did not change significantly on the 1st,3rd and 7th day,and the difference was not statistically significant(P>0.05)3.The optimal threshold of serum NFL was 37.42 pg/ml,the AUC was 0.809,sensitivity was 0.701,specificity was 0.817 and Yoden index 0.518.The optimal threshold of serum SBDP145 was 1.63ng/ml,the AUC was 0.750,sensitivity was 0.673,specificity was 0.917 and Yoden index 0.490.The AUC,sensitivity,specificity and Yoden index of serum NFL combined with SBDP145 were 0.898,0.778,0.867 and0.645,respectively.Conclusion:The levels of Serum NFL and SBDP145 can reflect brain injury in premature infants,and can be used as biochemical indexes to predict its occurrence and development,the predictive effect of serum NFL combined with SBDP145 is better than single serum NFL and SBDP145. |
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