Gazzolo Diego, Marinoni Emanuela, Di Iorio Romolo, Bruschettini Matteo, Kornacka Maria, Lituania Mario, Majewska Urszula, Serra Giovanni, Michetti Fabrizio
Department of Pediatrics, G. Gaslini Children's University Hospital, Genoa, Italy.
Crit Care Med. 2004 Jan;32(1):131-6. doi: 10.1097/01.CCM.0000104116.91462.CD.
Hypoxic-ischemic encephalopathy (HIE) is one of the major causes of perinatal mortality and morbidity. To date, there are no reliable methods to detect which infants will develop brain damage after asphyxia insult.
Prospective study conducted in three tertiary departments of neonatology from December 1999 to July 2002.
A total of 44 infants with perinatal asphyxia and 68 control infants.
Routine laboratory variables, neurologic patterns, ultrasound imaging, and urine concentrations of S100B protein were determined at nine time points.
The concentrations of S100B protein in urine were measured using an immunoluminometric assay at first urination and 4, 8, 12, 16, 20, 24, 48, and 72 hrs after birth. The results were correlated with the presence or absence of hypoxic-ischemic encephalopathy. Routine laboratory parameters and neurologic patterns were assessed at the same time as urine sampling.
S100B protein levels were significantly higher in samples collected at all monitoring time points from newborns with perinatal asphyxia with or without hypoxic-ischemic encephalopathy than in samples from normal infants (all p <.001). When asphyxiated infants were subdivided according to the presence of mild or absence of hypoxic-ischemic encephalopathy (group A) and of moderate or severe hypoxic-ischemic encephalopathy (group B), S100B levels were significantly higher at all the predetermined monitoring time points in group B infants than group A or control infants (all p <.001). An S100B concentration cutoff of 0.41 microg/L at first urination had a sensitivity of 91.3% and a specificity of 94.6% for predicting the development of hypoxic-ischemic encephalopathy. The sensitivity and specificity of measurements obtained from 4 to 72 hrs after birth were up to 100% and 98.8%, respectively.
Longitudinal S100B protein measurements in urine soon after birth are a useful tool to identify which asphyxiated infants are at risk of hypoxic-ischemic encephalopathy and its possible neurologic sequelae.
缺氧缺血性脑病（HIE）是围产期死亡率和发病率的主要原因之一。迄今为止，尚无可靠方法来检测哪些婴儿在窒息损伤后会发生脑损伤。
1999年12月至2002年7月在三个新生儿科三级部门进行的前瞻性研究。
共有44例围产期窒息婴儿和68例对照婴儿。
在九个时间点测定常规实验室指标、神经学模式、超声成像以及尿S100B蛋白浓度。
出生后首次排尿及4、8、12、16、20、24、48和72小时时，采用免疫发光分析法测定尿中S100B蛋白浓度。结果与缺氧缺血性脑病的有无相关。在采集尿液样本的同时评估常规实验室参数和神经学模式。
无论有无缺氧缺血性脑病，围产期窒息新生儿在所有监测时间点采集的样本中S100B蛋白水平均显著高于正常婴儿样本（所有p<.001）。当窒息婴儿根据有无轻度缺氧缺血性脑病（A组）和有无中度或重度缺氧缺血性脑病（B组）进行细分时，B组婴儿在所有预定监测时间点的S100B水平均显著高于A组或对照婴儿（所有p<.001）。首次排尿时S100B浓度截断值为0.41μg/L，预测缺氧缺血性脑病发生的敏感性为91.3%，特异性为94.6%。出生后4至72小时测量的敏感性和特异性分别高达100%和98.8%。
出生后不久对尿液中的S100B蛋白进行纵向测量是一种有用的工具，可用于识别哪些窒息婴儿有发生缺氧缺血性脑病及其可能的神经后遗症的风险。
