Talvik T, Haldre S, Sööt A, Hämarik M, Piirsoo A, Mikelsaar A V
Department of Pediatrics, Children's Hospital, University of Tartu, Estonia.
Acta Paediatr. 1995 Oct;84(10):1183-7. doi: 10.1111/j.1651-2227.1995.tb13521.x.
Creatine kinase isoenzyme BB was determined in cerebrospinal fluid (CSF) in 79 preterm neonates using an original enzyme-linked immunosorbent assay. The criterion for inclusion was an Apgar score of 7 or less at 5 min of life. Neurological examination was performed on day 2 and day 5 of life. CSF was obtained on the same days. Lumbar puncture was performed on 41 of these babies on day 2 and in 39 on day 5 of life (one baby underwent lumbar puncture twice). All babies had clinical features of hypoxic-ischemic encephalopathy (HIF) which was classified according to Sarnat and Sarnat. The control group consisted of 90 asphyxiated term babies and 30 adults without CNS pathology. The concentration of CK-BB in cerebrospinal fluid (mean +/- SD) was significantly higher (p < 0.0005) in preterm (168.0 +/- 2) than in term babies (29.0 +/- 3.1) and healthy adults (5.3 +/- 1.2). Our results demonstrate the possibility of using the classification system of Sarnat and Sarnat for assessment of the severity of brain damage not only in term, but also in preterm babies. Neonates with HIE stages II and III showed markedly higher CK-BB values than those with HIE I on day 2 (p < 0.025) and day 5 (p < 0.05) of life. CK-BB values were markedly higher in preterm babies with none of some primitive responses (head turning, Babkin's reflex, palmar grasp). The mean concentration of CK-BB was higher in neonates with retarded psychomotor development compared with those with normal development (p < 0.05) on day 3, and after 6 and 9 months. At 12 months of age no significant difference in median CK-BB concentration was detected between neonates with normal and developmental disturbances.
采用原创的酶联免疫吸附测定法，对79例早产儿的脑脊液（CSF）中的肌酸激酶同工酶BB进行了测定。纳入标准为出生后5分钟时阿氏评分≤7分。在出生后第2天和第5天进行神经系统检查。在同一天采集脑脊液。其中41例婴儿在出生后第2天进行腰椎穿刺，39例在出生后第5天进行腰椎穿刺（1例婴儿接受了两次腰椎穿刺）。所有婴儿均有缺氧缺血性脑病（HIF）的临床特征，并根据萨纳特和萨纳特的方法进行分类。对照组由90例窒息足月儿和30例无中枢神经系统病变的成年人组成。早产儿脑脊液中CK - BB的浓度（均值±标准差）显著高于足月儿（29.0±3.1）和健康成年人（5.3±1.2）（p<0.0005）。我们的结果表明，萨纳特和萨纳特的分类系统不仅可用于评估足月儿，也可用于评估早产儿脑损伤的严重程度。在出生后第2天（p<0.025）和第5天（p<0.05），II期和III期HIE的新生儿CK - BB值明显高于I期HIE的新生儿。在没有一些原始反射（转头、巴布金反射、握持反射）的早产儿中，CK - BB值明显更高。在出生后第3天、6个月和9个月时，精神运动发育迟缓的新生儿的CK - BB平均浓度高于发育正常的新生儿（p<0.05）。在12个月大时，发育正常和发育障碍的新生儿之间未检测到CK - BB中位数浓度的显著差异。
