热性惊厥患儿外周血泛素羧基末端水解酶L1、神经烯醇化酶表达水平及临床意义

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摘要目的探讨热性惊厥患儿外周血泛素羧基末端水解酶L1（UCH-L1）、神经烯醇化酶（NSE）表达水平。方法回顾性分析2017年1月—2019年6月安徽省芜湖市第二人民医院（以下简称“我院”）收治的97例热性惊厥患儿为病例组，根据疾病类型将其分为单纯性热性惊厥组（单纯组，55例），复杂性热性惊厥组（复杂组，42例）；根据预后情况将其分为预后良好组（76例）和预后不良组（21例）。选取同期于我院急诊科就诊的高烧并最后确诊为急性上呼吸道感染的60例患儿为对照组。比较各组临床资料，分析热性惊厥患儿血清UCH-L1、NSE水平与临床资料的相关性，评估血清UCH-L1、NSE对热性惊厥及不良预后的诊断价值。结果病例组血糖、乳酸、UCH-L1、NSE水平均高于对照组，血红蛋白水平低于对照组（均P < 0.01）。复杂组血糖、乳酸、UCH-L1、NSE水平均高于单纯组，血红蛋白水平低于单纯组（均P < 0.01）。预后不良组血糖、乳酸、UCH-L1、NSE水平均高于预后良好组，血红蛋白水平低于预后良好组（均P < 0.01）。热性惊厥患儿血清UCH-L1、NSE水平与发作次数、发作持续时间、血糖、乳酸呈正相关（r ＞ 0，P < 0.05），与血红蛋白呈负相关性（r ＜ 0，P < 0.05）。UCH-L1诊断热性惊厥的截断值为2.23 ng/mL，曲线下面积（AUC）为0.878（95%CI：0.839~0.917），灵敏度、特异性分别为0.83、0.87；NSE诊断热性惊厥的截断值为9.85 ng/mL，AUC为0.838（95%CI：0.792~0.885），灵敏度、特异性分别为0.77、0.83；UCH-L1联合NSE诊断热性惊厥的AUC为0.915（95%CI：0.886~0.944），灵敏度、特异性分别为0.86、0.92。UCH-L1预测热性惊厥患儿不良预后的截断值为3.65 ng/mL，AUC为0.818（95%CI：0.768~0.853），灵敏度、特异性分别为0.77、0.86；NSE预测热性惊厥患儿不良预后的截断值为18.79 ng/mL，AUC为0.798（95%CI：0.760~0.834），灵敏度、特异性分别为0.75、0.82；UCH-L1联合NSE预测热性惊厥患儿不良预后的AUC为0.931（95%CI：0.889~0.964），灵敏度、特异性分别为0.83、0.89。结论血清UCH-L1、NSE表达上调参与了热性惊厥患儿发病过程，并且与脑损伤程度密切相关，早期联合检测可作为诊断热性惊厥和预测预后的重要指标。

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关键词 ：热性惊厥, 泛素羧基末端水解酶L1, 神经烯醇化酶, 诊断, 预后

Abstract：Objective To investigate the expression levels of ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1) and neuron-specific enolase (NSE) in peripheral blood of children with febrile convulsion. Methods Retrospective analysis was performed on 97 children with febrile convulsion admitted to the Second People’s Hospital of Wuhu, Anhui Province (“our hospital” for short) from January 2017 to June 2019 as case group. They were divided into simple febrile convulsion group (simple group, 55 cases) and complex febrile convulsion group (complex group, 42 cases) according to disease type; according to the prognosis, the patients were divided into good prognosis group (76 cases) and poor prognosis group (21 cases). A total of 60 children with high fever diagnosed as acute upper respiratory tract infection were selected as control group. Clinical data of each group was compared, the correlation between serum UCH-L1 and NSE levels in children with febrile convulsion and clinical data was analyzed, and the diagnostic value of serum UCH-L1, NSE and adverse prognosis in febrile convulsion were evaluated. Results The levels of blood glucose, lactic acid, UCH-L1 and NSE in case group were higher than those in control group, and the level of hemoglobin in case group was lower than that in control group (all P < 0.01). The levels of blood glucose, lactic acid, UCH-L1 and NSE in complex group were higher than those in simple group, and the level of hemoglobin in complex group was lower than that in simple group (all P < 0.01). The levels of blood glucose, lactic acid, UCH-L1 and NSE in poor prognosis group were higher than those in good prognosis group, and the level of hemoglobin was lower than that in the good prognosis group (all P < 0.01). The levels of UCH-L1 and NSE in children with febrile convulsion were positively correlated with frequency of seizures, duration of seizures, blood glucose and lactic acid (r > 0, P < 0.05), and negatively correlated with hemoglobin (r < 0, P < 0.05). The cut-off value of UCH-L1 in the diagnosis of febrile convulsion was 2.23 ng/mL, area under the curve (AUC) was 0.878 (95%CI: 0.839-0.917), the sensitivity and specificity were 0.83 and 0.87, respectively. The cut-off value of NSE in the diagnosis of febrile convulsion was 9.85 ng/mL, AUC was 0.838 (95%CI: 0.792-0.885), the sensitivity and specificity were 0.77 and 0.83, respectively. The AUC of UCH-L1 combined with NSE in the diagnosis of febrile convection was 0.915 (95%CI: 0.886-0.944), and the sensitivity and specificity were 0.86 and 0.92, respectively. The cut-off value of UCH-L1 for predicting adverse prognosis in children with febrile convulsion was 3.65 ng/mL, AUC was 0.818 (95%CI: 0.768-0.853), the sensitivity and specificity were 0.77 and 0.86, respectively. The cut-off value of NSE for predicting adverse prognosis in children with febrile convulsion was 18.79 ng/mL, AUC was 0.798 (95%CI: 0.760-0.834), the sensitivity and specificity were 0.75 and 0.82, respectively. The AUC of UCH-L1 combined with NSE for predicting poor prognosis in children with febrile convulsion was 0.931 (95%CI: 0.889-0.964), and the sensitivity and specificity were 0.83 and 0.89, respectively. Conclusion The up-regulated expression of UCH-L1 and NSE in serum is involved in the pathogenesis of children with febrile convulsion, and is closely related to the degree of brain injury. Early combined detection can be used as an important indicator for diagnosis of febrile convulsion and prediction of prognosis.

Key words： Febrile convulsion Ubiquitin carboxy-terminal hydrolase-L1 Neuron-specific enolase Diagnosis Prognosis

基金资助:安徽省卫生计生委科研计划项目（2017YK52）。

作者简介: 李迟佳（1985.12-），女，硕士；研究方向：儿童呼吸道疾病。

引用本文:

李迟佳王红群. 热性惊厥患儿外周血泛素羧基末端水解酶L1、神经烯醇化酶表达水平及临床意义[J]. 中国医药导报, 2021, 18(8): 82-86,101.
LHI Chijia WANG Hongqun. Expression levels of ubiquitin carboxy-terminal hydrolase-L1 and neuron-specific enolase in peripheral blood of children with febrile convulsion and their clinical significance. 中国医药导报, 2021, 18(8): 82-86,101.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2021/V18/I8/82

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