The Application And Evaluation Of S100β,NSE,Lac And IBI In Premature Infants With Brain Injury

Objective Brain injury in premature infants(BIPI)is one of the common diseases of preterm infant,can seriously affect the long-term prognosis and quality of life in preterm neonates.Due to immature cerebral vessels and poor ability of the cerebral blood flow adjustment,cerebral hemodynamics appear to disorder easily,as well as premature neurons,oligodendrocytes and its precursor are sensitive to hypoxia ischemia,low resistance and high vulnerability,which lead to significantly higher morbidity of premature brain damage and neurological sequelae than those in premature group.In the early phase of injury,lack of obvious signs and symptoms of nervous system,it is easy to misdiagnosis and miss optimal time for treatment,less than 32 weeks premature infants,especially the very preterm infant are at higher risk.In this study,through three serologic index(Neuron specific enolase(NSE),S100βand lactic acid(Lac))and interburst intervals(IBI)of electroencephalogram(EEG),which compare to cranial ultrasound and magnetic resonance imaging(MRI),the aim of the study is to evaluate three serological index and IBI in the diagnosis of brain injury in premature infants on the degree of sensitivity and specificity,get the working curve and its area,and conclude the correlation between S100β,NSE,Lac and IBI to Neonatal Behavioral Neurological Assessment(NBNA)or hearing.Methods This experiment is a prospective clinical diagnostic test.According to the including and excluding standard,all the subject which gestational age is less than 32 week and birth weigh is less than 1500 grams,will be collected the blood at the first day,the third day and the seventh day,meanwhile at the first day,corrected age of 32 week and corrected age of 36 week,all the preterm will have EEG monitoring,at the same time,within the first week after birth and every two weeks later or according to the needs,all the subject will achieve cranial ultrasound,when corrected age of 37 weeks or before discharge,will be completed MRI,NBNA and hearing,and all the general hospital information and related disease of subjects will be recorded.According to the results of the ultrasound and MRI,finally,the subjects can be divided into brain injury and non-brain injury group,serological examination and IBI will be compared with ultrasound and MRI results,to conclude the sensitivity,specificity and subjects of working curve,and get the relationship between S100β,NSE,Lac,IBI and NBNA,hearing,calculate the assessment of NSE,S100β,Lac and IBI.All the data are using SPSS13.0 software for statistical analysis.Results1.Result of peripheral serological index The first day after birth,the area under the receiver operating characteristic curves(AUC)of S100β,NSE and Lac were 0.699,0.755,0.763 respectively.The third day after birth,the AUC of S100β,NSE and Lac were 0.745,0.731,0.593,respectively.The seventh day after birth,the AUC of S100β,NSE and Lac were were0.662,0.501,0.470,the diagnostic value of three were declining gradually(P < 0.05).2.Result of EEG monitoring The first day after birth,corrected age of 32 weeks and corrected age of 36 weeks,the AUC of IBI were 0.570,0.693,0.721(P < 0.05).3.Relationship between serological index,EEG monitoring and NBNA or hearing The score of NBNA in brain injury group was significantly lower than the non-brain injury group(34.95±0.38,35.94±0.37,t=-3.716,P<0.05).By chi-square test,the difference in two groups of hearing screening was statistically significant(X2=4.006,P < 0.05).According to the AUC of four indicators at various time,our study selected NSE and Lac of the first day,S100β of the third day,IBI of EEG with corrected gestational age 36 weeks as experimental factors.The factors was negative correlated with NBNA score(r NSE=-0.456,r Lac=-0.483,r S100β=-0.544,r IBI=-0.269,P < 0.01).By Logistic regression analysis,S100βand IBI were related to the occurrence of hearing abnormalities(ORS100β =4.758,ORIBI =2.126,P < 0.05,),through Wald test of regression coefficient,all the result have statistical significance.Conclusion1.The 1 day after birth,AUC of NSE and Lac were bigger than the 3 days and 7 days after birth,which showed the highest diagnosis value.By the same method,the AUC of S100β protein at the third day and the AUC of IBI at corrected age of 36 week were higher,and more sensitive and more specific.2.AUC of NSE,S100β protein and Lac were significantly elevated in the early after birth,can be used as biochemical indexes in early diagnosis of brain damage,but because of the influence of the half-life,the diagnostic value was declining with increasing day age.With the growth of gestational age,AUC of IBI was increased,IBI can be served as indexes which coordinated ultrasound and MRI in post diagnosis,make up for the inadequacy of serological indexes in the late diagnosis.3.The concentration of NSE,S100β protein,Lac and IBI are negative correlated with NBNA score.S100βand IBI are related to the occurrence of hearing abnormalities.4.NSE、S100β、Lac and IBI can use to assess the short-term prognosis of nervous system damage,and remind clinical doctor to treat the patient as soon as possible,in order to improve the quality of life.