Objective: To explore the changes of serum neuron-specific enolase (NSE) and myelin basic protein (MBP) in children with cerebral palsy at high altitude during comprehensive rehabilitation and their clinical significance. Methods: A clinical randomized controlled study design was used to select 144 children with cerebral palsy who were diagnosed and treated in the Rehabilitation Center of Xining Traditional Chinese Medicine Hospital of Qinghai Province from June 2018 to October 2019, including 83 males and 61 females, aged 3-5 years old. According to the order of admission, the random number table was used to divide into a conventional treatment group (n=72, 40 males and 32 females) and a comprehensive treatment group (n=72, 43 males and 29 females). The conventional treatment group was treated with conventional rehabilitation. The comprehensive treatment group was treated with monosialotetrahexose ganglioside sodium on the basis of conventional rehabilitation. In addition, 30 healthy children aged 3-5 years, 16 males and 14 females, were selected as the control group during the physical examination of the Pediatrics Department of Xining Hospital of Traditional Chinese Medicine, Qinghai Province. The serum levels of NSE and MBP in each group were detected, and the children's GMFM-88 scores were evaluated before and after treatment. The SPSS19.0 software was used for statistical analysis, the count data was tested by χ2. Results: The serum NSE and MBP levels of the control group were (5.96±0.80), (0.71±0.15) μg/L. Before treatment, the serum NSE and MBP levels of children with severe, moderate, and mild cerebral palsy were [(21.63±1.92), (3.63±0.49) μg/L], [(17.86±1.43) μg/L, (2.21±0.07) μg/L] and [(15.14±0.95), (1.76±0.30) μg/L], respectively. After treatment, the serum NSE and MBP levels of the conventional treatment group and the comprehensive treatment group were [(13.54±2.41), (2.07±0.85) μg/L] and [(12.09±2.37), (1.81±0.69) μg/L], respectively, and the GMFM-88 score was (116.75±27.41) points and (125.94±24.93) points. The levels of NSE and MBP in the serum of children with cerebral palsy were significantly higher than those of normal children in the control group, and their levels increased with the degree of disease, and the corresponding gross motor function scores were lower. After treatment, the GMFM-88 scale assessment scores of the two groups of children were significantly improved (t values were 310.97 and 70.86, P values were both<0.05), and serum NSE and MBP levels decreased to varying degrees compared with before treatment. The decline in the comprehensive treatment group was greater than that in the conventional treatment group. Conclusions: Serum NSE and MBP levels in children with cerebral palsy at high altitude are significantly higher than those in healthy children, and their levels are closely related to the degree of impairment and GMFM-88 scores in children with cerebral palsy. Dynamic monitoring of changes in NSE and MBP levels may be responsible for the condition and treatment effects of children with cerebral palsy judgments based.
目的： 探讨高原地区脑瘫患儿的血清神经元特异性烯醇化酶（NSE）和髓鞘碱性蛋白（MBP）在综合康复过程中的水平变化及其临床意义。 方法： 采用临床随机对照研究设计，选取2018年6月至2019年10月青海省西宁市中医院康复中心诊治的脑瘫患儿144例，其中男83例、女61例，年龄为3~5岁。根据入院顺序，采用随机数字表法分为常规治疗组（72例，男40例、女32例）和综合治疗组（72例，男43例、女29例），常规治疗组采用常规康复治疗，综合治疗组在常规康复的基础上加用单唾液酸四己糖神经节苷酯钠治疗。另选取30名同期于青海省西宁市中医院儿保科体检，年龄为3~5岁的健康儿童，男16名、女14名作为对照组。检测各组血清中NSE、MBP含量，并于治疗前后评估患儿GMFM-88量表得分。采用SPSS19.0 软件进行统计学分析，计数资料采用χ²检验。 结果： 对照组血清NSE、MBP水平为（5.96±0.80）、（0.71±0.15） μg/L。治疗前，重度、中度、轻度脑瘫患儿血清NSE、MBP水平分别为［（21.63±1.92）、（3.63±0.49） μg/L ］、［（17.86±1.43）、（2.21±0.07） μg/L］和［（15.14±0.95）、（1.76±0.30） μg/L］。治疗后，常规治疗组和综合治疗组血清NSE、MBP水平分别为［（13.54±2.41）、（2.07±0.85） μg/L］和［（12.09±2.37）、（1.81±0.69） μg/L］，GMFM-88评分分别为（116.75±27.41）分和（125.94±24.93）分。脑瘫患儿血清中NSE、MBP含量明显高于对照组正常儿童，其水平随病情程度增加而升高，对应粗大运动功能评分越低。治疗后，两组患儿GMFM-88量表评估得分均显著提高（t值分别是310.97、70.86，P值均<0. 05），血清NSE、MBP水平较治疗前均不同程度下降，综合治疗组下降幅度大于常规治疗组。 结论： 高原地区脑瘫患儿血清NSE、MBP浓度较健康儿童显著升高，其含量与脑瘫患儿障碍程度及GMFM-88评分密切相关，动态监测NSE、MBP水平变化可能是脑瘫患儿病情及治疗效果的判断依据。.
Keywords: Cerebral palsy; Ganglioside sodium; Myelin basic protein; Neuron-specific enolase; Rehabilitation.