【摘要】 目的探讨肌酸激酶脑型同工酶(CK-BB)与脑干诱发电位(BAEP)对新生儿胆红素脑损伤早期诊断的临床价值。方法实验组病例选自2004年1月至2005年3月入住本院新生儿室的新生儿高胆红素血症病例71例。其中,男性病例37例,女性34例。实验组病例均符合新生儿高胆红素血症诊断标准。选同期上述单位产科母婴同室30例正常新生儿作为对照组,其中男性16例,女性14例。所有病例均于入院当日抽取外周静脉血液送检,测定肝功能(含胆红素)及CK-BB,并行BAEP检查,再于治疗后复查肝功能、CK-BB及BAEP。用SPSS统计软件进行数据处理,以P<0.05为差异有显著意义。结果本研究表明,胆红素的神经细胞毒性,可引起患儿神经系统损伤。实验组与对照组血清CK-BB各组之间总体均数不全相等,重度高胆红素血症组与对照组比较,CK-BB明显高于正常对照组。高胆红素血症组血清CK-BB与BAEP异常率及BAEP各波的波潜伏期(PL),波间潜伏期(IPL)与对照组相比,差异有显著意义。高胆红素血症组治疗后与对照组BAEP各波PL,IPL比较,轻度高胆红素血症组各波的PL,IPL延长不明显。重度高胆红素血症组BAEP的～,～IPL与对照组相比延长,显示高胆红素血症引起的中枢性听觉传导通路有损伤,提示脑损伤特异性酶的释放增加及听觉传导通路的损害。结论CK-BB与BAEP可用于胆红素脑损伤的早期诊断。对CK-BB与BAEP异常者应及早干预,以预防胆红素脑病的发生。更多还原

【Abstract】 Objective To study the value of creatine kinase bb(CK-BB)for early diagnosing of bilirubin encephalopathy and the relationship between creatine kinase bb and brain-stem auditory evoked response(BAEP).Then to find bilirubin induced-brain damage earlier and prevent its sequela.Methods 71 cases full term neonates within 1～7 days old are divided into 4 groups according to their total serum bilirubin(TSB)concentration.There are 28 newborns in the first test group,whose TSB are 220.6～256.5 μmol/L;The second test group includes 22 neonates,whose TSB are 256.5～342.0 μmol/L;The third group includes 21 neonates,whose TSB are more than 342.0 μmol/L.There are 30 newborns in the control group,whose TSB are less than 220.6 μmol/L.None of the infants showed any other symptoms of kernicterus except for jaundice.BAEP and CK-BB detected in neonates.All measure datum were presented as Mean±SD,the difference between the group were calculated by the t-test or F-test and q-test.We used the frequencies to present the classified datum,and used the χ2-test to calculated the difference between different groups.P<0.05 was considered significant.Results The result of the jaundice neonates are compared with the those of the controls:CK-BB in the moderate and severe hyperbilirubinemia are more than those of the control group and there are significant differences(P<0.05).Both of the BAEP mean latencies of waves and inter-peaks of two test groups are prolonged(P<0.05),The abnormal rates of BAEP of the two groups are higher than that of the control group(P<0.01).For the abnormal BAEP of the hyperbilirubinemia,its serum CK-BB concentration is higher than those of the normals(P<0.01).After treatment,the BAEP mean latencies of waves and inter-peaks are decreased,there are no significant differences compared with the control group except for the IPL of Ⅰ～Ⅲ,and Ⅰ～Ⅴ in the severe hyperbilirubinemia.Conclusion CK-BB and BAEP are changed before some of full term jaundice neonates show the symptoms of kernicterus.So they can be used for early diagnoses bilirubin induced-brain damage.更多还原