| Objective: Asphyxia newborn is the most Primary cause of the perinataldeath, and in China the rate of asphyxia newborn was significantly higher thanthat of developed countries.That asphyxia-hypoxic lead to multiple organdysfunction is an important cause of death, at the same time, it is alsoconsidered to be the initiating organ in the multiple organfailure.Dvorak[3]found that the gastrointestinal tract maybe the first organ thatbe involved by asphyxia. The symptoms of neonatal are often hidden, thatoffen impact on the judgment of clinical. So that, look for a sensitive andspecific objective indicator of the response to gastrointestinal dysfunction isnecessary to guidance the treatment of asphyxia neonatal. Diamine oxidase(DAO) is a intracellular enzyme which has an important effect in polyaminemetabolic processes from the deamination and it widely distributed in themammalian mucosa or fluff layer, which accounts for about95%of the totalexist in the small intestine mucosa and villus epithelial cells; when theintestine is injuried by hypoxic-ischemic, DAO detached from the necrosis ofthe intestinal mucosal cells,and then into the lymphatic vessels and capillariesof the intestinal cell gap, so that,the DAO of blood levels is reduce in theintestinal mucosa,but rise in normal circumstances.The serum that can bedetected by the DAO is extremely rare[20].Therefore, it can be used as a goodindicator to reflect the structure and function of the small intestinal. Fatty acidbinding protein (FABP) is a group of low molecular weight (about15kD) incombination with a long chain fatty acid binding protein, which has an strongorganization-specific. It exists in the mammalian's cardiac muscle, smallintestine, liver, adipose tissue, brain and epidermis et al specific tissues, and itis one of the valuable biological indicator monitoring of tissue injury in emerging. I-FABP, is one of the nine types of FABP that had beenfound,I-FABP is widely distributed in the small intestine mucosa microvilli tipand accounting for2%to3%of the total protein of intestinal mucosa. Underphysiological conditions, the I-FABP levels in the peripheral blood of minimal,almost undetectable[23].However, when subjected to hypoxia, ischemia andreperfusion injury of the intestinal villi, the blood flow of the countercurrentexchange mechanism to promote the necrosis of the intestinal villus tip cells,increased permeability of intestinal epithelial cells, I-FABP release, throughthe capillaries and the thoracic duct into the blood circulation, so can bedetected in the peripheral blood[16]. Serum I-FABP in the room temperature,save its activity can still keep95%of the total activity after24hours, so it isquite stable, and suitable for clinical examination of the actual operation[21-22]At present there is no research on levels of I-FABP and DAO in the field ofasphyxia neonatal, the experiment by measuring the levels of mild and severeasphyxia in neonatal serum in I-FABP, DAO, to understand the earlyhypoxic-ischemic neonates with asphyxia gastrointestinal dysfunctionsituation, if necessary, early intervention, to control the disease at an earlystage, to fight for the timing for the treatment of critically ill patients.Method: Fifty asphyxia neonates were selected from neonatology in TheHebei medical university Fourth Hospital and maternal and child care servicecentre of Baoding who were divided to two groups according to Apgar scoreabout seven version of pediatric: slight asphyxia group and serious asphyxiagroup. There are30in former,20in latter,and20in control group.The controlgroup have no asphyxia, no infection, no congenital disease andgastrointestinal reaction. Record gestational age,delivery way,weight and sexfor comparative analysis.The criteria of case-exclusion which were selectedare:①in preterm infants;②congenital malformations in vital organs (heartand kidney brain);③congenital gastrointestinal disease;④infectiousdiseases. Group by New Seventh Edition of pediatrics Apgar score, To extractthe neonatal's Venous blood1.0mL who are the first day and the third afterbirth, injected heparin tube, and3000r/min for15min centrifugal separation plasma, the test set-70℃refrigerator.Test method are ELISA andcolorimetric, the DAO and I-FABP levels were measured in plasma samplescollected. The basis of the diagnostic criteria of gastrointestinal dysfunction:abdominal distension, bowel sounds diminished or disappeared, coffee groundvomit et al symptoms and signs[8]. Gastrointestinal dysfunction score wasslightly modified on the basis of the1995National Conference on CriticalCare[24]:(see Table17).Statistical analysis was performed using SPSS13.0software package, Allmeasurement data showed by means±standard deviation (X±S),enumerationdata showed by rate.Comparison of many groups was performed by theOne-Way ANOVA,and multiple comparisons between groups used SNK.P<0.05was considered significant. Comparison of disease incidence wasperformed by the chi-square test, P<0.05was considered significant.(correlation analysis test level α=0.01, P <0.01was considered significant).Results:(1) The clinical data of the selected children: Differencescompared among the three groups of neonates, gestational age, gender, weight,et al. the result of the Equilibrium Analysis is they have no statisticaldifference (P>0.05).(See Table1)(2) The level of DAO and I-FABP in neonatal plasma in the experimentalgroup and control group changes: the first day after birth in the three groups,by the single factor analysis of variance, the level of DAO and I-FABP inexperimental group are obviously higher than those in the control group,andsevere suffocation groupare obviously higher than mild asphyxia group, arestatistically significant (P <0.05)(see Table2,4).5days after birth, the mildasphyxia group back to normal level,with no obvious difference compared tothe control group(P>0.05).The severe asphyxia group still higher than thosein the control group and mild asphyxia group (P <0.05). The first day afterbirth,the level of DAO in the control group plasma are7.3755±0.76u/ml,thelevel of I-FABP are49.76±8.29ng/l.5days after birth, the level of DAO are7.25±0.74u/ml, the level of I-FABP are50.29±6.023ng/l, The comparison between first day after birth and5days after birth has no statistical differenceon the control group (see Table3,5).(3) The incidence of gastrointestinal dysfunction in mild asphyxia groupand the severe asphyxia group:20cases of severe asphyxia group were:gastrointestinal dysfunction occurs17cases;30cases of children with mildasphyxia group: gastric intestinal dysfunction for17cases. Both the incidenceof the difference was statistically significant (P <0.05).(See Table6)(4) The correlation with DAO(I-FABP)and the score of gastrointestinaldysfunction：By first day, the correlation of the plasma DAO's levels and thescore of gastrointestinal dysfunction is significantly,r1=0.884, P <0.01(Fig.1);By the fifth day,the correlation of the plasma DAO's levels and thescore of gastrointestinal dysfunction is significantly also,r5=0.905, P <0.01(Fig.2); By first day, the correlation of I-FABP's levels and the score ofgastrointestinal dysfunction is significantly,r1=0.814, P <0.01(Fig.3); thefifty day of the correlation is very obvious,r5=.918, P <0.01(Fig.4); and theDAO and I-FABP's levels on the two time points was positively correlated(No.1day r1=0.958,5day r5=0.905), P <0.01.(Fig.7,8)(5) The evaluation of DAO and I-FABP levels in the diagnosis ofgastrointestinal dysfunction: The analysis of ROC (Receiver operatingcharacteristic curve) curve is(the diagnosis standard is gastrointestinaldysfunction score): the sensitivity of DAO is88.2%, specificity degree is87.5%; sensitivity of I-FABP is89.2%, specificity degree is87.6%.Conclusion:(1) The level of DAO and I-FABP has correlation with thedegree of asphyxia and the incidence of gastrointestinal dysfunction, whichwere increasing with the degree of asphyxia and the incidence ofgastrointestinal dysfunction.(2) The change of the level of DAO and I-FABP in first and fifth day hascorrelation,which has correlation with the score of gastrointestinaldysfunction,especially in first.The change of it suggest that the tendency ofthe two index is agreement after asphyxia. Monitoring DAO and I-FABP canforecast the incidence of gastrointestinal dysfunction,which is the best and objective index to reflect gastrointestinal function of the newborn.(3) DAO and I-FABP are sensitivity and specificity indexs for diagnosisof gastrointestinal dysfunction after asphyxia,which is better than gastrointest-inal dysfunction scored. It indicates that DAO and I-FABP are moreobjective,timely and sensitivity for diagnosis of gastrointestinal dysfunctionafter asphyxia. |
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