Perinatal asfiksi tanı ve prognozunda Nöron-Spesifik Enolaz'ın yeri ve önemi
Küçük Resim Yok
Tarih
1999
Yazarlar
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Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
85 ÖZET Nöron spesifik enolaz enzimi, beyin hasarını ilgilendiren serebrovasküler olaylar, koma, ensefalit, kafa travması ve perinatal asfiksi gibi durumlarda artmakta ve bu hastalıklarda hem tam, hem de prognoz için kullanılmaktadır. Bu çalışma term yenidoğanlarda yapılmış olup, perinatal asfıkside tanı ve prognoz açısından NSE'nin değeri belirlenmeye çalışılmıştır. Çalışma grubuna 43 HİE'li yenidoğan bebek (Grup 1), 29 amniotik sıvıda mekonyum bulunan, fakat fizik muayeneleri normal olarak değerlendirilen 29 yenidoğan (Grup 2), Kontrol Grubunda ise fizik muayenelerinde patoloji saptanmayan spontan vajinal yolla doğmuş 30 sağlıklı term bebek seçilmiştir. Olgulardan NSE düzeyini tayin etmek üzere, doğumdan sonra ilk 72 saat ve 5-7 günde iki kan örneği alınması planlanmış, Kontrol Grubundan ve örnek alma zamanına kadar ölen veya kontrole gelmeyen olgulardan ikinci örnek alınmamıştır. Birinci örnek sonuçlan Grup l'de ortalama 76,7 ± 45,4, Grup 2'de 42,0 + 24,0, Kontrol Grubunda 21,0 ± 5,3 ug/L bulunmuş, Grup l'deki olgularda, hem Grup 2 hem de Kontrol Grubuna göre anlamlı yükseklik saptanmıştır (p,.2< 0,05; Pı-Konm,ı < 0,001). İkinci kan örnekleri Grup 1 için 42,5 + 28,6, Grup 2 için 22,1 ± 8,0 ug/L olarak tesbit edilmiştir (p< 0,05). Ayrıca NSE birinci kan örnek değerlerinin HİE evresine göre de değişiklik gösterdiği saptanmıştır. HİE Evre l'deki olgularda bu değer ortalama 65,3 ± 32,4, Evre 2'de 64,6 ± 32,9, Evre 3 'de ise 115,7 ± 60,9 ug/L olarak değerlendirilmiştir. Bu sonuçlara göre, Evre 1 ile Evre 2 arasında anlamlı farklılık olmadığı halde Evre 3'ün sonuçları, hem Evre 1 ve hem de Evre 2'deki olguların sonuçlarmdan anlamlı olarak yüksek bulunmuştur (p< 0,05). İkinci örneklerde Evre l'de 34,6 + 13,9, Evre 2'de 42,0 ± 32,7, Evre 3'de 70,8 + 36,9 |ug/L değeri elde edilmiştir. Evre 3'deki olguların sonuçları ile Evre 2 arasmda farklılık bulunmamış, ancak Evre 1 sonuçlarma göre farklılık saptanrnıştır (p<0,05). Grup 2 ve Kontrol Grubunda herhangi bir patoloji gözlenmezken, Grup l'deki olguların 8'i (%18,6) ölmüş, 1 yıllık takipde yaşayan olguların ll'inde (%31,4) nöromotor defisit gelişmiştir. Ölüm veya sekel görülen olguların hepsinde hem 1. hem de 2. örneklerde yüksek değerler saptanmıştır. 1. örneklerde > 127,2 jıg/L saptanan olgular ile ikinci kan örneklerinde > 63,9 ug/L saptanan tüm olgularda prognozun kötü olduğu görülmüştür. Sonuç olarak, NSE'nin hem erken tam, hem de prognoz tayininde kullanılabilecek bir parametre olduğu saptanmıştır.
86 SUMMARY THE EFFICACY OF NEURON SPECIFIC ENOLASE IN THE DIAGNOSIS AND PROGNOSIS OF PERINATAL ASPHYXIA Neuron specific enolase (NSE) is an enzyme which increases in cases associated with brain damage such as cerebrovascular disorders, coma, encephalitis, cranial trauma, perinatal asphyxia and is used for both diagnosis and prognosis of these entities. This research has been carried out in term newborn babies to determine the efficacy of NSE in the diagnosis and prognosis of perinatal asphyxia. The study groups comprised of 43^ newborn babies with Hypoxic Ischemic Encephalopathy (HIE) (Group 1), 29 neonates with meconium stained amniotic fluid but with normal physical examination (Group 2). 30 healthy term newborn babies who were born after spontaneous vaginal delivery and with normal physical findings were included in the control group. In the study groups, two blood examples were taken to measure NSE levels, one during the first 72 hours of life and the other 5-7 days after birth. However, it was not possible to take a second sample from those in the control group, those who were lost during follow-up or died. The mean serum concentrations of NSE of the first blood samples were 76,7 + 45,4 ug/L for Group 1, 42,0 ± 24,0 ug/L for Group 2, 21,0 + 5,3 ug/L for Control Group (PaT? i-2< 0,05, pcroup i- control < 0,001). The mean NSE concentrations of the second samples were 42,5 ± 28,6 ug/L for Group 1, 22,1 ± 8,0 ug/L for Group 2 (p< 0,05). Besides, it was found that serum NSE concentrations of the first blood samples were closely correlated with HIE stage (Sarnat & Sarnat), mean NSE concentrations being 65,3 + 32,4 ug/L in stage I, 64,6 ± 32,9 ug/L in stage II, 115,7 + 60,9 ug/L in stage III (p^ !_3 and p^ 2-3 < 0,05, Paage i-2> 0,05). The mean NSE concentrations of the second samples were 34,6 + 13,9 ug/L in stage I, 42,0 + 32,7 ug/L in stage II, 70,8 + 36,9 ug/L in stage III. (p^ M< 0,05, Pstage i-2< 0,05, Paage 2-3> 0,05). While none of the patients in Group 2 and Control Group had a pathological follow-up and course, in Group 1, 8 patients (%18,6) died and 11 patients (%31,4) were observed to have sequela, after 1 year follow-up. In those patients who either died or developed sequela the serum NSE concentrations were high both in the first and second blood samples. All those cases whose serum concentrations of the first samples were > 127,2 ug/L and > 63,9 ug/L in the second samples had poor prognosis. In conclusion, NSE is a good marker for both the early diagnosis and prognosis of asphyxia.
86 SUMMARY THE EFFICACY OF NEURON SPECIFIC ENOLASE IN THE DIAGNOSIS AND PROGNOSIS OF PERINATAL ASPHYXIA Neuron specific enolase (NSE) is an enzyme which increases in cases associated with brain damage such as cerebrovascular disorders, coma, encephalitis, cranial trauma, perinatal asphyxia and is used for both diagnosis and prognosis of these entities. This research has been carried out in term newborn babies to determine the efficacy of NSE in the diagnosis and prognosis of perinatal asphyxia. The study groups comprised of 43^ newborn babies with Hypoxic Ischemic Encephalopathy (HIE) (Group 1), 29 neonates with meconium stained amniotic fluid but with normal physical examination (Group 2). 30 healthy term newborn babies who were born after spontaneous vaginal delivery and with normal physical findings were included in the control group. In the study groups, two blood examples were taken to measure NSE levels, one during the first 72 hours of life and the other 5-7 days after birth. However, it was not possible to take a second sample from those in the control group, those who were lost during follow-up or died. The mean serum concentrations of NSE of the first blood samples were 76,7 + 45,4 ug/L for Group 1, 42,0 ± 24,0 ug/L for Group 2, 21,0 + 5,3 ug/L for Control Group (PaT? i-2< 0,05, pcroup i- control < 0,001). The mean NSE concentrations of the second samples were 42,5 ± 28,6 ug/L for Group 1, 22,1 ± 8,0 ug/L for Group 2 (p< 0,05). Besides, it was found that serum NSE concentrations of the first blood samples were closely correlated with HIE stage (Sarnat & Sarnat), mean NSE concentrations being 65,3 + 32,4 ug/L in stage I, 64,6 ± 32,9 ug/L in stage II, 115,7 + 60,9 ug/L in stage III (p^ !_3 and p^ 2-3 < 0,05, Paage i-2> 0,05). The mean NSE concentrations of the second samples were 34,6 + 13,9 ug/L in stage I, 42,0 + 32,7 ug/L in stage II, 70,8 + 36,9 ug/L in stage III. (p^ M< 0,05, Pstage i-2< 0,05, Paage 2-3> 0,05). While none of the patients in Group 2 and Control Group had a pathological follow-up and course, in Group 1, 8 patients (%18,6) died and 11 patients (%31,4) were observed to have sequela, after 1 year follow-up. In those patients who either died or developed sequela the serum NSE concentrations were high both in the first and second blood samples. All those cases whose serum concentrations of the first samples were > 127,2 ug/L and > 63,9 ug/L in the second samples had poor prognosis. In conclusion, NSE is a good marker for both the early diagnosis and prognosis of asphyxia.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
