Murray Deirdre M
Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
Handb Clin Neurol. 2019;162:281-293. doi: 10.1016/B978-0-444-64029-1.00013-8.
The widespread introduction of therapeutic hypothermia as a standard of care in hypoxic-ischemic encephalopathy (HIE) has brought increasing pressure on clinicians to make an early and accurate assessment of the degree of hypoxic injury (HI) that has occurred and the severity of the encephalopathy that will ensue. No single blood-based marker is currently robust enough to detect significant HI or predict outcome. However, research in the field has been active in the last 10 years and we know that HIE is associated with predictable alterations in the expression of a number of inflammatory proteins, neuron-specific proteins, metabolite pathways, and microRNA. These alterations evolve quickly over the first hours and days of life. Predictive power varies depending on the timing of measurement of the biomarker, the sample type, and the case mix of the cohort examined. Combining clinical data with biochemical measurements is currently the most likely path toward improved detection and prediction of outcome in neonatal HIE.
治疗性低温作为缺氧缺血性脑病（HIE）的标准治疗方法被广泛采用，这给临床医生带来了越来越大的压力，要求他们尽早准确评估已发生的缺氧损伤（HI）程度以及随后将出现的脑病严重程度。目前，没有单一的血液标志物强大到足以检测出显著的HI或预测预后。然而，该领域在过去10年一直积极开展研究，我们知道HIE与多种炎症蛋白、神经元特异性蛋白、代谢途径和微小RNA的表达发生可预测的变化有关。这些变化在生命的最初几个小时和几天内迅速演变。预测能力因生物标志物的测量时间、样本类型以及所研究队列的病例组合而异。目前，将临床数据与生化测量相结合是改善新生儿HIE检测和预后预测的最可行途径。
