The clinical research of serum glial fibrillary acidic protein combined with craniocerebral MRI in neonatal hypoxic-ischemic encephalopathy / 中国医师杂志

ABSTRACT

Objective To explore the relationship between serum glial fibrillary acidic protein (GFAP) level and neonatal hypoxic-ischemic encephalopathy (HIE),and to verify whether GFAP combined with craniocerebral magnetic resonance imaging (MRI) can more accurately evaluate the prognosis of HIE.Methods We selected HIE children who hospitalized in the department of neonatology,the affiliated hospital of Inner Mongolia Medical University from January 2017 to December 2017,and full-term newborns without brain injury who were hospitalized in the same period.Serum samples were taken for GFAP detection on the 1st,3rd,7th day after birth of HIE and the 3rd day after birth of full-term newborns without brain injury.All the subjects completed craniocerebral MRI examination and followed up.At the same time,the correlation between GFAP level and the severity of brain MRI was evaluated.Results (1) The level of serum GFAP in HIE group on the 3rd day after birth [(5.54 ± 1.30)ng/ml] was significantly higher than that in control group [(3.38 ± 0.31) ng/ml] (P ＜ 0.01).(2) Comparison of serum GFAP levels in HIE children with different degrees:the serum levels of GFAP in the severe group on the 1st,3rd and 7th day were as follows:(5.56 ± 1.89) ng/ml,(6.42 ± 1.63) ng/ml,(7.22 ± 1.30) ng/ml;the serum levels of GFAP in moderate group on the 1st,3rd and 7th day were as follows:(5.07 ±0.62)ng/ml,(6.73 ±0.772) ng/ml,(6.25 ±0.812)ng/ml;the serum levels of GFAP in mild group on the 1st,3rd and 7th day were as follows:(4.20 ±-0.13) ng/ml,(5.34 ±0.33) ng/ml,(4.52 ±0.33) ng/ml;the serum GFAP levels in severe group were higher than those in moderate group and mild group on the 1st,3rd and 7th day,and those in moderate group were higher than those in mild group (P ＜ 0.01).(3) Comparison of serum GFAP levels between sequelae group and non-sequelae group:there was no significant difference between sequelae group [(5.22 ± 1.52) ng/ml,(6.48 ± 1.17) ng/ml] and non-sequelae group [(4.47 ± 0.50)ng/ml,(5.75 ±0.88) ng/ml] on the 1st and 3rd day (P ＞0.05);there was significant difference between sequelae group [(6.93 ± 1.29) ng/ml] and non-sequelae group [(4.91 ± 0.77) ng/ml] on the 7th day (P ＜0.01).(4) Comparison of serum GFAP levels between abnormal group of MRI and normal group of MRI:the levels of serum GFAP on day 1,3 and 7 in abnormal craniocerebral MRI group were as follows:(5.25 ± 1.28) ng/ml,(6.66 ± 1.10) ng/ml,(6.64 ± 1.08) ng/ml;the levels of serum GFAP on day 1,3 and7 in the normal group of MRI were as follows:(4.26 ±0.25)ng/ml,(5.41 ±0.40) ng,/ml,(4.62 ±0.48) ng/ml;the serum levels of GFAP on day 1,3 and 7 in mild abnormal craniocerebral MRI group were as follows:(4.92 ±0.9)ng/ml,(6.42 ±0.47)ng/ml,(5.95 ±0.58)ng/ml;the levels of serum GFAP on day 1,3 and 7 in moderate abnormal group of craniocerebral MRI were as follows:(4.49 ± 0.58) ng/ml,(6.24 ± 1.87) ng/ml,(6.11 ± 0.08) ng/ml;the levels of serum GFAP on day 1,3 and 7 in the severe abnormal group of craniocerebral MRI were as follows:(6.17 ± 1.34) ng/ml,(7.22 ± 0.91) ng/ml,(7.73 ± 1.01)ng/ml.Among the three groups of abnormal group of craniocerebral MRI,there were no significant differences in serum GFAP levels on day 1 and 3 (P ＞ 0.05),and there were significant differences on day 7 (P ＜ 0.05).Conclusions It is speculated that the increase of serum GFAP level in HIE newborns is related to the severity and prognosis of the disease,and is positively related to the results of craniocerebral MRI examination.Detecting the changes of serum GFAP in HIE newborns is helpful to determine the severity of the disease and evaluate the prognosis of the children.Combining GFAP with craniocerebral MRI may improve the accuracy of the judgment.