探讨改良振幅整合脑电图(aEEG)评分联合血清神经元特异性烯醇化酶(NSE)水平，对新生儿胆红素脑损伤的早期预测价值。

选择2017年3月至2018年2月，于苏北人民医院新生儿病房住院治疗的80例高胆红素血症新生儿为研究对象。根据头颅MRI检查结果是否有苍白球高信号改变，将其分为脑损伤组(n＝37)及无脑损伤组(n＝43)；并选择本院产科同期出生的40例健康足月新生儿为对照组。对3组受试儿进行aEEG监测，并进行改良aEEG评分，检测血清总胆红素(TBiL)浓度及NSE水平，以及脑干听觉诱发电位(BAEP)。对3组受试儿一般临床资料、改良aEEG评分、血清TBiL浓度及NSE水平，采用单因素方差分析及最小显著性差异法(LSD)-t检验，进行总体比较及两两比较；对改良aEEG评分、血清NSE水平及aEEG分度分别与BAEP分度的相关性，采用Spearman秩相关分析法；绘制受试者工作特征曲线(ROC)，比较改良aEEG评分、血清NSE水平及二者联合，对高胆红素血症新生儿发生胆红素脑损伤的预测价值。本研究遵循本院伦理委员会所制定的伦理学标准，并得到批准(审批文号：2016KY-064)，所有纳入对象监护人知情同意。

①3组新生儿性别构成，入院时日龄及胎龄，出生时体重、身长、头围及胸围，以及其母亲孕次、产次比较，差异均无统计学意义(P>0.05)。②脑损伤组新生儿的改良aEEG评分为(7.7±1.6)分，分别低于无脑损伤组及对照组的(10.4±1.5)分和(10.9±1.3)分；而血清TBiL浓度及NSE水平分别为(349.7±74.0) μmol/L、(47.6±13.2) μg/L，均分别高于无脑损伤组的(295.7±31.4) μmol/L、(32.3±7.7) μg/L及对照组的(185.1±35.9) μmol/L、(28.6±7.3) μg/L，并且差异均有统计学意义(均为P<0.001)。③本研究受试儿的改良aEEG评分与BAEP分度呈负相关关系(r_s＝-0.718，P<0.001)，血清NSE水平及aEEG分度，均与BAEP分度呈正相关关系(r_s＝0.685，P<0.001；r_s＝0.647，P<0.001)。④改良aEEG评分、血清NSE水平及二者联合，预测高胆红素血症新生儿发生胆红素脑损伤的ROC曲线下面积(ROC-AUC)分别为0.875(95%CI：0.795～0.954，P<0.001)，0.853(95%CI：0.769～0.937，P<0.001)及0.938(95%CI：0.861～0.980，P<0.001)；3种方法预测脑损伤的敏感度分别为86.5%、62.2%、83.8%，特异度分别为74.4%、93.0%、90.7%。

改良aEEG评分联合血清NSE水平，对新生儿胆红素脑损伤的早期预测价值，较单一采用改良aEEG评分或血清NSE水平更高。

To explore early predictive value of scores of modified amplitude integrated electroencephalogram (aEEG) combined with serum level of neuron specific enolase (NSE) in newborns with neonatal bilirubin brain injury.

From March 2017 to February 2018, a total of 80 cases of newborns with hyperbilirubinemia who were hospitalized in neonatal ward of Northern Jiangsu People′s Hospital were selected as research subjects. According to results of head MRI examination of being present high signal changes in globus pallidus or not, they were divided into brain injury group (n=37) and non brain injury group (n=43). Meanwhile, there were 40 cases of healthy and full term newborns who born in the same hospital were selected as control group. For newborns in above 3 groups, their aEEG was monitored, and scores of aEEG were performed; serum concentration of total bilirubin (TBiL) and level of NSE, and brainstem auditory evoked potential (BAEP) were detected. The general clinical data, score of modified aEEG, serum concentration of TBiL and level of NSE of newborns in 3 groups were overall compared and further compared between each two groups by one-way ANOVA and least significant difference (LSD)-t test. Spearman rank correlation analysis was used to analyze correlation between score of modified aEEG, serum level of NSE, aEEG degree respectively, and BAEP degree. Receiver operating characteristic curve (ROC) was drawn to compare predictive value of score of modified aEEG, serum level of NSE and combination of these two indicators of bilirubin brain injury in neonates with hyperbilirubinemia. This study followed the ethical standards formulated by the Ethics Committee of our hospital, and was approved (Approval No. 2016KY-064). All guardians of included subjects were informed concents.

①There were no significant differences among 3 groups in gender composition, admission age and gestational age, weight, height, head and chest circumference at birth of newborns, and pregnancy and parity of their mothers (P>0.05). ② Scores of modified aEEG of newborns in brain injury group was (7.7±1.6) scores, which was lower than those of (10.4±1.5) scores and (10.9±1.3) scores in non brain injury group and control group, respectively; while serum concentration of TBiL and level of NSE were (349.7±74.0) μmol/L and (47.6±13.2) μg/L, respectively, which were significantly higher than those of (295.7±31.4) μmol/L and (32.3±7.7) μg/L in brain injury group, and those of (185.1±35.9) μmol/L and (28.6±7.3) μg/L in control group, and all the differences were statistically significant (all P<0.001). ③ For all subjects in this study, score of modified aEEG was negatively correlated with BAEP degree (r_s=-0.718, P<0.001), serum level of NSE and aEEG degree were both positively correlated with BAEP degree (r_s=0.685, P<0.001; r_s=0.647, P<0.001). ④ Area under curve of ROC (ROC-AUC) of score of modified aEEG, serum level of NSE and combination of these two indicators for prediction of bilirubin brain injury of neonates with hyperbilirubinemia were 0.875 (95%CI: 0.795-0.954, P<0.001), 0.853 (95%CI: 0.769-0.937, P<0.001) and 0.938 (95%CI: 0.861-0.980, P<0.001), respectively, the sensitivity of these three methods for prediction of brain injury of newborns were 86.5%, 62.2%, 83.8%, and the specificity were 74.4%, 93.0%, 90.7%, respectively.

The early predictive value of score of modified aEEG combined with serum level of NSE was higher than that of score of modified aEEG or serum level of NSE only.