Florio Pasquale, Perrone Serafina, Luisi Stefano, Vezzosi Piero, Longini Mariangela, Marzocchi Barbara, Petraglia Felice, Buonocore Giuseppe
Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
Clin Chem. 2006 Aug;52(8):1516-21. doi: 10.1373/clinchem.2005.065979. Epub 2006 Jun 1.
Intraventricular hemorrhage (IVH) is a major cause of neurologic disabilities in preterm newborns. We evaluated the use of plasma activin A concentrations to predict the development of perinatal IVH.
We measured nucleated erythrocyte (NRBC) counts, plasma activin A, hypoxanthine (Hyp), and xanthine (Xan) in arterial blood samples obtained from 53 preterm infants during the first hour after birth. Cerebral ultrasound was performed within 48 h of birth and repeated at 5- or 6-day intervals until the age of 4 weeks.
Grade I or II IVH was detected during the first 10 days of life in 11 of 53 patients (21%). Activin A, Hyp, and Xan concentrations and NRBC counts were higher in preterm newborns who subsequently developed IVH than in those who did not (P<0.0001, except P=0.019 for Xan). Neonatal activin A was correlated (P<0.0001) with Hyp (r=0.95), Xan (r=0.90), and NRBC count (r=0.90) in newborns without later IVH and in those who developed IVH (Hyp, r=0.89, P=0.0002; Xan, r=0.95, P<0.0001; NRBC count, r=0.90, P=0.0002). At a cutoff of 0.8 microg/L activin A, the sensitivity and specificity were 100% [11 of 11; 95% confidence interval (CI), 71%-100%] and 93% (39 of 42; 95% CI, 81%-98%), and positive and negative predictive values were 79% (95% CI, 61%-100%) and 0% (95% CI, 0%-2%), respectively. The area under the ROC curve was 0.98.
Activin A concentrations at birth are increased in preterm newborns who later develop IVH and may be useful for early identification of infants with hypoxic-ischemic brain insults who are at high risk for IVH.
脑室内出血（IVH）是早产新生儿神经功能障碍的主要原因。我们评估了血浆激活素A浓度用于预测围产期IVH发生的情况。
我们测量了53例早产儿出生后1小时内采集的动脉血样本中的有核红细胞（NRBC）计数、血浆激活素A、次黄嘌呤（Hyp）和黄嘌呤（Xan）。在出生后48小时内进行脑超声检查，并每隔5或6天重复一次，直至4周龄。
53例患者中有11例（21%）在出生后的前10天内检测到I级或II级IVH。随后发生IVH的早产新生儿的激活素A、Hyp和Xan浓度以及NRBC计数高于未发生IVH的新生儿（P<0.0001，Xan除外，P=0.019）。在未发生IVH的新生儿和发生IVH的新生儿中，新生儿激活素A与Hyp（r=0.95）、Xan（r=0.90）和NRBC计数（r=0.90）相关（P<0.0001）（Hyp，r=0.89，P=0.0002；Xan，r=0.95，P<0.0001；NRBC计数，r=0.90，P=0.0002）。激活素A的临界值为0.8μg/L时，敏感性和特异性分别为100%[11/11；95%置信区间（CI），71%-100%]和93%（39/42；95%CI，81%-98%），阳性和阴性预测值分别为79%（95%CI，61%-100%）和0%（95%CI，0%-2%）。ROC曲线下面积为0.98。
随后发生IVH的早产新生儿出生时激活素A浓度升高，可能有助于早期识别有缺氧缺血性脑损伤且发生IVH风险高的婴儿。
