Nagdyman N, Kömen W, Ko H K, Müller C, Obladen M
Department of Neonatology, Institute of Laboratory Medicine, Charité University Hospital, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Pediatr Res. 2001 Apr;49(4):502-6. doi: 10.1203/00006450-200104000-00011.
Hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia is a condition in which serum concentrations of brain-specific biochemical markers may be elevated. Neuroprotective interventions in asphyxiated newborns require early indicators of brain damage to initiate therapy. We examined brain-specific creatine kinase (CK-BB), protein S-100, and neuron-specific enolase in cord blood and 2, 6, 12, and 24 h after birth in 29 asphyxiated and 20 control infants. At 2 h after birth, median (quartiles) serum CK-BB concentration was 10.0 U/L (6.0-13.0 U/L) in control infants, 16.0 U/L (13.0-23.5 U/L) in infants with no or mild HIE, and 46.5 U/L (21.4-83.0 U/L) in infants with moderate or severe HIE. Serum protein S-100 was 1.6 microg/L (1.4-2.5 microg/L) in control infants, 2.9 microg/L (1.8-4.7 microg/L) in asphyxiated infants with no or mild HIE, and 17.0 microg/L (3.2-34.1 microg/L) in infants with moderate or severe HIE 2 h after birth. No significant difference was detectable in serum neuron-specific enolase between infants with no or mild and moderate or severe HIE 2 and 6 h after birth. A combination of serum protein S-100 (cutoff value, 8.5 microg/L) and CK-BB (cutoff value, 18.8 U/L) 2 h after birth had the highest predictive value (83%) and specificity (95%) of predicting moderate and severe HIE. Cord blood pH (cutoff value, <6.9) and cord blood base deficit (cutoff value, >17 mM) increase the predictive values of protein S-100 and CK-BB. We conclude that elevated serum concentrations of protein S-100 and CK-BB reliably indicate moderate and severe HIE as early as 2 h after birth.
围产期窒息后发生的缺氧缺血性脑病（HIE）是一种脑特异性生化标志物血清浓度可能升高的病症。对窒息新生儿进行神经保护干预需要脑损伤的早期指标来启动治疗。我们检测了29例窒息婴儿和20例对照婴儿脐带血以及出生后2、6、12和24小时的脑特异性肌酸激酶（CK-BB）、蛋白S-100和神经元特异性烯醇化酶。出生后2小时，对照婴儿血清CK-BB浓度中位数（四分位数）为10.0 U/L（6.0 - 13.0 U/L），无或轻度HIE的婴儿为16.0 U/L（13.0 - 23.5 U/L），中度或重度HIE的婴儿为46.5 U/L（21.4 - 83.0 U/L）。出生后2小时，对照婴儿血清蛋白S-100为1.6 μg/L（1.4 - 2.5 μg/L），无或轻度HIE的窒息婴儿为2.9 μg/L（1.8 - 4.7 μg/L），中度或重度HIE的婴儿为17.0 μg/L（3.2 - 34.1 μg/L）。出生后2小时和6小时，无或轻度HIE与中度或重度HIE婴儿的血清神经元特异性烯醇化酶无显著差异。出生后2小时血清蛋白S-100（临界值，8.5 μg/L）和CK-BB（临界值，18.8 U/L）联合使用对预测中度和重度HIE具有最高的预测价值（83%）和特异性（95%）。脐带血pH（临界值，<6.9）和脐带血碱缺失（临界值，>17 mM）可提高蛋白S-100和CK-BB的预测价值。我们得出结论，血清蛋白S-100和CK-BB浓度升高可在出生后2小时就可靠地指示中度和重度HIE。
