| Objective:To investigate the changes of cytochrome P450(CYP450)and caspase-3 in cerebrospinal fluid(CSF)in neonatal bilirubin encephalopathy(NBE),and to explore the clinical significance in NBE.Methods:Thirty-three cases of full-term severe hyperbilirubinemia within 14 days in the general neonatology ward of Hunan Provincial Children's Hospital from August 2015 to December 2017 were used as the observation group(ie,the severe hyperbilirubinemia group),randomly selected 33 patients without hyperbilirubinemia during the same period as a control group(ie,non-hyperbilirubinemia group).Children with severe hyperbilirubinemia according to the presence or absence of bilirubin encephalopathy were further divided into severe hyperbilirubinemia without bilirubin encephalopathy group(n=10)and severe hyperbilirubinemia with bilirubin encephalopathy group(n=23).All subjects(n=66)underwent CSF examination within 24 hours after admission.Enzyme-linked immunosorbent assay(ELISA)was used to determine the levels of CYP450 and caspase-3 in CSF of children.Simultaneous examination of blood routine,liver function,and laboratory indicators of CSF routine,biochemical,culture,bilirubin concentrations,etc.The changes of CYP450 and caspase-3 in CSF in each group were compared and the difference was found.The correlation between CYP450 level and indirect bilirubin(IBIL)concentration in CSF,total serum bilirubin(TSB)level,serum bilirubin/albumin(B/A)ratio was analyzed.To investigate the sensitivity and specificity of IBIL/CYP450 ratio in the diagnosis of neonatal bilirubin encephalopathy in CSF.The changes of CYP450 and caspase-3 levels in CSF were compared between groups and the differences were found;the levels of CYP450 and indirect bilirubin(IBIL),the level of total serum bilirubin(TSB),and serum bilirubin in CSF were compared.The correlation between CYP450 level and indirect bilirubin(IBIL)concentration in CSF,total serum bilirubin(TSB)level,serum bilirubin/albumin(B/A)ratio was analyzed,so as to investigate the sensitivity and specificity of IBIL/CYP450 ratio of CSF in the diagnosis of neonatal bilirubin encephalopathy.Results:1.There was no significant difference in gender,gestational age,birth weight,and hospital admission weight among the groups(P>0.05),and they were comparable.2.The concentration of IBIL M(QR)in CSF of the children in the non-hyperbilirubinemia group,severe hyperbilirubinemia without bilirubin encephalopathy group,and severe hyperbilirubinemia with bilirubin encephalopathy group were 3.17(2.63,3.94)? mol/L,5.72(5.17,6.63)? mol/L,and 10.97(9.83,13.87)? mol/L,respectively,there was a statistically significant difference between groups at P<0.05;the M(QR)of CYP450 content in the three groups of CSF was 27.18(26.34,28.41)pg/mL,28.76(27.45,29.60)pg/mL,28.63(27.23,29.92)pg/mL,respectively,there was a statistically significant difference between groups at P<0.05.3.The Spearman correlation analysis of CYP450 with IBIL in CSF,peak of TSB,and serum B/A ratio was performed.The r,values were 0.390,0.295,and 0.311,P<0.05,respectively,suggesting a positive correlation.4.The ROC curve showed that the area under the curve(AUC)of IBIL/CYP450 ratio in CSF was 0.952,the best critical value was 0.30,the sensitivity was 0.91,and the specificity was 1.00.5.The content of caspase-3 in severe hyperbilirubinemia with bilirubin encephalopathy group was(28.79 ± 1.49)ng/mL,which was slightly higher than that in hyperbilirubinemia without bilirubin encephalopathy group(28.47 ± 1.24)ng/mL,there was no statistically significant difference between the two groups(P>0.05).Conclusion:1.The content CYP450 in CSF was positively correlated with peak of TSB,serum B/A ratio,and IBIL concentration in CSF.2.When the ratio of IBIL/CYP450 ratio in CSF is greater than 0.30,it has certain value in diagnosing neonatal bilirubin encephalopathy.3.This study did not find that the level of caspase-3 in children with neonatal bilirubin encephalopathy was higher than that in children without bilirubin encephalopathy. |
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