Predictive value of umbilical vein blood brain-derived neurotrophic factor level for brain injury of neonates delivered by the pregnant with gestational diabetes mellitus
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摘要:目的 探讨妊娠期糖尿病（GDM）孕妇分娩的新生儿脐血脑源性神经营养因子水平（BDNF）对脑损伤的预测价值。方法 选择92例GDM足月分娩产妇为观察组，同期选择健康产妇80例为对照组。基于产后3 d颅脑超声、核磁共振成像（MRI）结合新生儿行为神经测定（NBNA）评分对新生儿是否发生脑损伤进行判定。采用酶联免疫分析（ELISA）法检测各组新生儿BDNF水平，比较观察组、对照组新生儿脑损伤发生率。采用受试者工作特征（ROC）曲线评估BDNF对GDM孕妇分娩的新生儿合并脑损伤的预测价值。结果 观察组新生儿脑损伤发生率及脐静脉血BDNF水平均高于对照组，新生儿NBNA评分低于对照组，差异有统计学意义（P < 0.05）。观察组脑损伤新生儿脐静脉血BDNF水平高于非脑损伤新生儿，NBNA评分低于非脑损伤新生儿，差异有统计学意义（P < 0.05）。对照组脑损伤、非脑损伤新生儿脐静脉血BDNF水平、NBNA评分比较，差异无统计学意义（P>0.05）。BDNF水平为13.8 μg/L时，约登指数最大，数值为0.346，此时曲线下面积为0.732，灵敏度及特异度分别为79.71%、55.86%。结论 GDM产妇足月分娩新生儿发生脑损伤的风险明显增高，早期检测脐静脉血BDNF水平对预测脑损伤的发生具有较好的预测性。Abstract:Objective To investigate the predictive value of umbilical vein blood brain-derived neurotrophic factor(BDNF) level for brain injury of neonates delivered by the pregnant with gestational diabetes mellitus(GDM).Methods A total of 92 full-term birth pregnant women with GDM were selected as observation group, while 80 healthy pregnant women were selected as control group. Based on the result of brain ultrasound, magnetic resonance imaging (MRI) and neonatal behavioral neuroassay (NBNA) score at 3 days postpartum, the neonatal brain injury conditions were determined. The umbilical vein blood BDNF levels were measured by enzyme-linked immunoassay (ELISA). The incidence of brain injury was compared between the observation group and the control group. The predictive value of cord blood BDNF for brain injury in full-term newborns was evaluated by Receiver Operating Characteristics (ROC) curve.Results The incidence of neonatal brain injury, and BDNF level in neonatal cord blood in the observation group were significantly higher than those in the control group (P < 0.05). The neonatal NBNA score in the observation group was significantly lower than that in the control group (P < 0.05). In observation group, the level of BDNF in neonatal cord blood of the brain injury neonates was higher, and the neonatal NBNA score in the brain injury group was lower than that in the non-brain injury ones (P < 0.05). There were no differences in BDNF level and NBNA score of brain injury between brain injury neonates and non-brain injury newborns in the control group (P>0.05). When the BDNF level was 13.8 μg/L, the Yodeng index was the highest, with its value of 0.346 and the area under the curve was 0.732, with sensitivity and specificity of 79.71% and 55.86%, respectively.Conclusion The risk of brain injury in the full-term newborns delivered by GDM mothers is higher, early detection of BDNF in umbilical vein blood has a good accuracy in predicting the occurrence of brain injury.
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表 1 2组一般临床资料比较(x±s)[n(%)]
临床资料 观察组(n=92) 对照组(n=80) 产妇年龄/岁 25.6±3.2 26.7±3.4 孕周/周 38.9±1.2 38.6±0.1 初产妇 55(59.8) 45(56.2) 经产妇 37(40.2) 35(43.8) 体质量指数/(kg/m2) 26.5±2.3 26.9±2.4 顺产 63(68.5) 53(66.3) 剖宫产 29(31.5) 27(33.7) 平均动脉压/mmHg 75.6±4.3 74.2±3.6 胆固醇/(mmol/L) 6.2±1.1 6.4±1.3 男性新生儿 50(54.3) 43(53.8) 女性新生儿 42(45.7) 37(46.2) 新生儿出生体质量/g 3 425.0±236.0 3 528.0±347.0 新生儿1 min Apgar评分/分 9.1±0.5 9.3±0.6 新生儿出生血糖/(mmol/L) 5.5±1.1 5.6±1.1 
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表 2 2组新生儿脑损伤、脐静脉血BDNF水平、NBNA评分比较(x±s)M(P25, P75)[n(%)]
组别 n 脑损伤 BDNF/(μg/L) NBNA/分 观察组 92 11(11.96)* 10.9(7.7, 11.2)* 33.27±8.23* 对照组 80 3(3.75) 8.1(3.5, 14.6) 38.34±9.16 BDNF: 脑源性神经营养因子; NBNA: 新生儿行为神经测定。与对照组比较, *P < 0.05。
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表 3 2组脑损伤、非脑损伤新生儿脐静脉血BDNF水平、NBNA评分比较
脑损伤情况 观察组 对照组 BDNF/(μg/L) NBNA/分 BDNF/(μg/L) NBNA/分 脑损伤 14.1(12.0, 14.8)* 31.07±6.67* 8.3(5.0, 9.6) 37.71±6.41 非脑损伤 7.6(4.8, 10.1) 35.61±7.35 7.9(4.3, 8.8) 39.56±5.88 BDNF: 脑源性神经营养因子; NBNA: 新生儿行为神经测定。
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