S100β蛋白、中性粒细胞/淋巴细胞比值及脑电图对新生儿缺氧缺血性脑病早期识别与病情评估的应用价值

The Application Value of S100β Protein, Neutrophil-to-Lymphocyte Ratio, and Electroencephalography for the Early Identification and Severity Assessment of Neonatal Hypoxic-Ischemic Encephalopathy

摘要: 目的：探讨血清S100β蛋白、中性粒细胞与淋巴细胞比值(NLR)及脑电图(EEG)在新生儿缺氧缺血性脑病(HIE)早期识别及病情程度评估中的临床应用价值。方法：选取2020年1月至2025年10月我院新生儿科收治的足月HIE患儿75例作为HIE组，并依据Sarnat分级将其划分为轻度组(n = 40)、中度组(n = 22)和重度组(n = 13)。选取同期具有出生窒息史但未确诊HIE的足月新生儿42例作为对照组(窒息非HIE组)。所有新生儿均在生后6小时内采集静脉血，检测血清S100β蛋白浓度并计算NLR；同时在生后24小时内完成床旁振幅整合脑电图(aEEG)监测。对HIE组的各个分组以及它们与对照组的各项指标进行比较，并通过ROC曲线分析来评估各项指标和联合检测在HIE早期诊断中的效果。结果：1) HIE组血清S100β蛋白水平、NLR值和aEEG背景活动异常率均显著高于窒息非HIE组(P < 0.01)。2) 在HIE组内，随着病情严重程度的增加，血清S100β蛋白水平和NLR值均呈现逐步升高趋势(P < 0.01)，aEEG背景活动也由连续正常电压(CNV)向不连续正常电压(DNV)过渡继而向爆发–抑制(BS)、低电压(LV)及平坦波(FT)变化。3) ROC曲线分析显示，血清S100β蛋白、NLR及aEEG对HIE均具有一定的诊断价值，其曲线下面积(AUC)分别为0.790、0.858和0.774。三者联合检测的诊断效能最高，AUC可达0.905，灵敏度和特异度分别为81.3%和90.5%。结论：血清S100β蛋白、NLR和aEEG是早期识别HIE和评估其病情严重程度的有效生物学和电生理学指标。三者联合检测能显著提高对HIE的诊断准确性，尤其有助于在存在出生窒息史的新生儿中早期、准确地甄别出真正发生HIE的患儿，为临床及时干预提供重要依据。

Abstract: Objective: The neutrophil-to-lymphocyte ratio (NLR) is employed to assess the clinical benefit of serum S100β protein and electroencephalography (EEG) for the early identification and severity thorough evaluation of neonatal hypoxic-ischemic encephalopathy (HIE). Methods: Our hospital’s neonatal department enrolled 75 full-term neonates with HIE from January 2020 to October 2025, forming the HIE group. They were further subdivided according to the Sarnat classification into mild (n = 40), moderate (n = 22), and severe (n = 13) subgroups. Forty-two full-term neonates, who had a history of birth asphyxia but no HIE diagnosis during the same period, were chosen as the control group (asphyxia non-HIE group). Venous blood samples were collected from all neonates within the first 6 hours of life to measure serum S100β protein concentrations and calculate the NLR. Bedside amplitude-integrated electroencephalography (aEEG) monitoring was also completed within the first 24 hours of life. A comparison between the HIE subgroups and the control group was made to assess the differences in these indicators. Receiver operating characteristic (ROC) curve analysis was used to evaluate the early diagnostic efficacy of individual indicators and their combination for HIE. Results: 1) The HIE group showed significantly higher serum S100β levels, NLR values, and aEEG background abnormality rates compared to the asphyxia non-HIE group (P < 0.01). 2) Within the HIE group, serum S100β levels and NLR values exhibited a stepwise increase with greater disease severity (P < 0.01). Furthermore, aEEG background activity progressively deteriorated, shifting from continuous normal voltage (CNV) to discontinuous normal voltage (DNV), and then to patterns including burst-suppression (BS), low voltage (LV), and flat tracing (FT). 3) ROC curve analysis indicated that serum S100β, NLR, and aEEG each possessed diagnostic value for HIE, with areas under the curve (AUC) of 0.790, 0.858, and 0.774, respectively. Notably, the combination of all three markers demonstrated the highest diagnostic performance, achieving an AUC of 0.905 with a sensitivity of 81.3% and a specificity of 90.5%. Conclusion: Serum S100β protein, NLR, and aEEG are effective biological and electrophysiological indicators for the early identification and severity assessment of HIE. Their combined use significantly enhances diagnostic accuracy for HIE. This approach is particularly valuable for the early and accurate identification of neonates with true HIE among those with a history of birth asphyxia, thereby providing a crucial basis for timely clinical intervention.