| Objective:To investigate the changing characteristics of GFAP,EPO and MMP-9 with diffierent severity in hypoxic-ischemic encephalopathy(HIE),and comparing the correlation between prognosis and severity in HIE of three biomarkers. To proved whether the three biomarkers have prediction effect on the early diagnosis and treatment of HIE, providing experimental basis for clinical setting indiidualized treatment.Methods: This study was a prospective cohort of newborns with a triple-blind experiment. From January 2013 to January 2015 in neonatal intensive care unit of Ba Yi Children’s Hospita l Affiliated to the General Military Hospital of Beijing PLA, a total of 60 cases with HIE was selected as subjects investigatedincluding 38 males and 22 females. Gestational ages of subjects were from 37 to 42 weeks,and the birth weight was from 2520 g to 4200 g. According to severity, 60 cases with HIE were divided into three groups including mild group, moderate group and severe group, each having 20. Each group was matched according to the, gender, BW,According to the gender, gestational age( GA), birth weight(BW) and delivery mode. Study on time points were selected included first,the seventh,the fourteenth and the twenty-first days after the onset of HIE.Neuronal glial fibrillary acidic protein(GFAP),erythropoietin(EPO) and matrix metalloproteinase-9(MMP-9)were measured in cerebrospinal fluid with enzymelinked immunosorbent assay(ELISA) in 1st, 7th,14 th and 21 th days of study on time points. a EEG was respectively traced and clinical data was recorded.Magnetic resonance imaging(MRI) was completed in 14 th and 21 th days of study on time points,and neonatal behaviral neurological assessment(NABA) was tested 21 th days of study on time points. SPSS 19.0 statistical software was used for data analysis, the statistics in accordance with the general linear model was tested repeatedly process,χ2test was used for count data, F test was used for the normal distribution and homogeneity of variance.Spearman analysis was used for correlation test.Results: 1. The same severity of HIE had different content of GFAP in cerebrospinal fluid in different time point. three groups were in the seventh time point for watershed. The contents of GFAP increased before the last drop, but different degree HIE had different rising and falling speed of content of GFAP. It was not statistical significance between mild group and moderate group from the 14 th day to 21 th days(p>0.05).There were statistically significant at the rest time points(p<0.05). The different severity of HIE had different content of GFAP in cerebrospinal fluid in the same time point(p<0.05).content of GFAP in the 1st,7thand 14 th days had statistically significant significance among mild, moderate and severe group(p<0.05),and the overall trend was mild group more than moderate group more than severe group in the 1st day while mild group less than moderate group less than severe group in the 7th and 14 th days. It was not statistical significance among three groups in the 21 th day(p>0.05). There were statistical significance between contents of GFAP and different prognosis in the 1st, 7th,14 th and 21 th days of study at time point(F=10.066, 4.337, 10.020, 8.877; p<0.05). It had strong positive correlation between contents of GFAP and prognosis in the 1st day(r=0.525, p<0.05)and the 21 th day(r=0.462, p<0.05),while having negative correlation in the 7th and 14 th days(r=-0.379,-0.512; p<0.05). 2. The same severity of HIE had different content of EPO in cerebrospinal fluid in different time point. Three groups were in the seventh time point for watershed. The contents of EPO presented upward trending after first drop, but had different falling and rising speed of content of EPO. It was not statistical significance in moderate group from the 14 th to 21 th days(p>0.05).There were statistical significance at the rest time points(p<0.05). The different severity of HIE had different content of EPO in cerebrospinal fluid in the same time point(p<0.05).In the 1st,14 th and 21 th days,there were statistically significant among three groups(p<0.05),and the trend was mild group more than moderate groupmore than severe group. But it was not statistical significance among three groups in the 7th day(p>0.05). There were statistically significant between contents of EPO and different prognosis in the 1st, 14 th and 21 th days(F=5.034,8.542, 7.424; p<0.05).It had positive correlation between contents of EPO and prognosis in the 1st,14 th and 21 th days(r=0.370, 0.497, 0.478; p<0.05),while no correlation in the 7th day(F=2.307; p=0.109). 3. The same severity of HIE had different content of MMP-9 in cerebrospinal fluid in different time point.It was not statistical significance in mild group from the 1st to the 21 th days(F=1.161, p>0.05)while it had statistical significance at different time points in moderate group(F=11.163, p<0.05).The content of MMP-9 fluctuated from the 1st day to the 21 th days, finally relatively stable. In severe group, it had statistical significance among the content of MMP-9 in different timg point(F=224.133, p<0.05).The different severity of HIE had different content of MMP-9 in cerebrospinal fluid in the same time point(p<0.05).In the 1st day, there were statistical significance among three groups(F=84.848, p<0.05),and the trend was severe group more than mild group more than moderate group. There were statistical significance between mild group and moderate group, moderate group and severe group in the 7th day(F=12.858, p<0.05). There were statistical significance between mild group and moderate group, mild group and severe group in the 14 th and 21 th days(F=18.620, 39.357; p<0.05). In the 21 th day,it was statistical significance between contents of MMP-9 and different prognosis(F=4.029, p<0.05),and had a correlation(r=0.347 p=0.007). 4. There were correlation analysis among three biomarkers with 60 cases of HIE.It had correlation between contents of GFAP and 60 cases of HIE in the 1st,7th and 14 th days(r=0.708, 0.554, 0.829; p<0.05). It had correlation between contents of EPO and 60 cases of HIE in the 1st,14 th and 21 th days(r=0.771, 0.882, 0.924; p<0.05).It had correlation between contents of MMP-9 and 60 cases of HIE in the 1st,14th and 21 th days(r=0.469, 0.540, 0.395; p<0.05).Conclusion: 1. The content of GFAP has a good correlation with clinical grading, different stage and prognosis of HIE. 2. The content of EPO has a good correlation with clinical grading, different stage and prognosi of HIE. 3. It has a correlation between the changed content of MMP-9 and the severity of HIE.The more serious the higher contents, especially in severe groups. 4. GFAP,EPO and MMP-9 are all associated with early clinical grading, different stage and prognosis of HIE. The correlation of EPO is the strongest, MMP-9 is the weakest. 5. GFAP、EPO and MMP-9 can be served as early predictors for diagnosis,treatment and prognosis of HIE. |
PDF Full Text Request