Talat Mohamed A, Saleh Rabab M, Shehab Mohammed M, Khalifa Naglaa A, Sakr Maha Mahmoud Hamed, Elmesalamy Walaa M
Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Clin Exp Pediatr. 2020 Aug;63(8):329-334. doi: 10.3345/cep.2019.01410. Epub 2020 Aug 15.
Birth asphyxia is a leading cause of neonatal mortality. Ischemia-modified albumin (IMA) levels may have a predictive role in the identification and prevention of hypoxic disorders, as they increase in cases of ischemia of the liver, heart, brain, bowel, and kidney.
This study aimed to assess the value of IMA levels as a diagnostic marker for neonatal hypoxic-ischemic encephalopathy (HIE).
Sixty newborns who fulfilled 3 or more of the clinical and biochemical criteria and developed HIE as defined by Levene staging were included in our study as the asphyxia group. Neonates with congenital malformation, systemic infection, intrauterine growth retardation, low-birth weight, cardiac or hemolytic disease, family history of neurological diseases, congenital or perinatal infections, preeclampsia, diabetes, and renal diseases were excluded from the study. Sixty healthy neonates matched for gestational age and with no maternal history of illness, established respiration at birth, and an Apgar score ≥7 at 1 and 5 minutes were included as the control group. IMA was determined by double-antibody enzymelinked immunosorbent assay of a cord blood sample collected within 30 minutes after birth.
Cord blood IMA levels were higher in asphyxiated newborns than in controls (250.83±36.07 pmol/mL vs. 120.24±38.9 pmol/mL). Comparison of IMA levels by HIE stage revealed a highly significant difference among them (207.3±26.65, 259.28±11.68, 294.99±4.41 pmol/mL for mild, moderate, and severe, respectively). At a cutoff of 197.6 pmol/mL, the sensitivity was 84.5%, specificity was 86%, positive predictive value was 82.8%, negative predictive value was 88.3%, and area under the curve was 0.963 (P<0.001).
IMA levels can be a reliable marker for the early diagnosis of neonatal HIE and can be a predictor of injury severity.
出生窒息是新生儿死亡的主要原因。缺血修饰白蛋白（IMA）水平在缺氧性疾病的识别和预防中可能具有预测作用，因为在肝脏、心脏、大脑、肠道和肾脏缺血的情况下其水平会升高。
本研究旨在评估IMA水平作为新生儿缺氧缺血性脑病（HIE）诊断标志物的价值。
符合3项或更多临床和生化标准且发展为Levene分期所定义的HIE的60例新生儿被纳入我们的研究作为窒息组。患有先天性畸形、全身感染、宫内生长迟缓、低体重、心脏或溶血性疾病、神经疾病家族史、先天性或围产期感染、先兆子痫、糖尿病和肾脏疾病的新生儿被排除在研究之外。60例胎龄匹配且母亲无疾病史、出生时建立呼吸且1分钟和5分钟Apgar评分≥7分的健康新生儿被纳入作为对照组。出生后30分钟内采集的脐血样本通过双抗体酶联免疫吸附测定法测定IMA。
窒息新生儿的脐血IMA水平高于对照组（250.83±36.07 pmol/mL对120.24±38.9 pmol/mL）。按HIE分期比较IMA水平发现它们之间存在高度显著差异（轻度、中度和重度分别为207.3±26.65、259.28±11.68、294.99±4.41 pmol/mL）。在截断值为197.6 pmol/mL时，敏感性为84.5%，特异性为86%，阳性预测值为82.8%，阴性预测值为88.3%，曲线下面积为0.963（P<0.001）。
IMA水平可作为新生儿HIE早期诊断的可靠标志物，并且可以作为损伤严重程度的预测指标。
