Abstract: Objective　To investigate the value of video electroencephalogram (VEEG) combined with peripheral blood inflammation indicators [total number of white blood cells (WBC), hypersensitive C-reactive protein (hs-CRP), and procalcitonin (PCT)] in the diagnosis of brain injury in premature infants, and to provide new clinical ideas for the evaluation of brain injury and its short-term prognosis in premature infants. Methods　The premature infants who were admitted to Affiliated Hospital of Yangzhou University from October 2020 to July 2021 and premature infants who were born in the obstetric department of other hospitals in the city with high risk factors of brain injury and transferred to neonatal intensive care unit of Affiliated Hospital of Yangzhou University within 24 hours were selected. According to the results of head magnetic resonance imaging (MRI) at 40 weeks of corrected gestational age, the premature infants were divided into a brain injury group and a non-brain injury group, with 28 cases in each group. In the brain injury group, there were 16 males and 12 females, with a gestational age of (32.83±2.09) weeks; there were 13 males and 15 females in the non-brain injury group, with a gestational age of (32.79±2.14) weeks. All preterm infants were examined by bedside VEEG within 1 week after birth and 2 ml of venous blood was collected on the 1st, 3rd, and 7th day after birth to detect the levels of WBC, hs-CRP, and PCT. The sensitivity and specificity of VEEG in the diagnosis of brain injury in premature infants were analyzed by four-grid table of diagnostic test, and the differences of WBC, hs-CRP, and PCT levels between the two groups at different time points were analyzed by ANOVA for repeated measurement. Results　The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy of VEEG in the diagnosis of brain injury in premature infants were 78.6% (22/28), 82.1% (23/28), 81.5% (22/27), 79.3% (23/29), 4.4, 3.8, and 80.4% respectively, and the Kappa value was 0.607. On the 1st day after birth, there was no statistically significant difference in the hs-CRP level between the two groups (P>0.05), the WBC and PCT levels in the brain injury group were higher than those in the non-brain injury group (both P<0.05). On the 3rd day after birth, the WBC, hs-CRP, and PCT levels in the brain injury group were higher than those in the non-brain injury group (all P<0.05). On the 7th day after birth, there were no statistically significant differences in the WBC and PCT levels between the two groups (both P>0.05), while the hs-CRP level was higher in the brain injury group (P<0.05). Conclusions　VEEG can be used as a reliable basis for the early diagnosis of brain injury in premature infants. The simultaneous increase of WBC, hs-CRP, and PCT levels on the 3rd day after birth often indicates the risk of brain injury in premature infants.

Key words: Premature infants, Brain injury, Video electroencephalogram, Total white blood cell count, Hypersensitive C-reactive protein, Procalcitonin

摘要： 目的　探讨视频脑电图（video electroencephalogram，VEEG）联合外周血炎症指标［血白细胞总数（white blood cells，WBC）、超敏C反应蛋白（hypersensitive C-reactive protein，hs-CRP）、降钙素原（procalcitonin，PCT）］在早产儿脑损伤诊断中的价值，为评估早产儿脑损伤及其近期预后提供新的临床思路。方法　选择2020年10月至2021年7月在扬州大学附属医院或本市其他医院产科出生，有脑损伤高危因素且24 h内转入扬州大学附属医院新生儿重症监护室的早产儿，根据纠正胎龄40周时的头颅磁共振（magnetic resonance imaging，MRI）结果分为脑损伤组和无脑损伤组，各28例。脑损伤组男16例，女12例，胎龄为（32.83±2.09）周；无脑损伤组男13例，女15例，胎龄为（32.79±2.14）周。所有早产儿均在生后1周内行床旁VEEG检查及采集生后第1天、第3天、第7天的静脉血2 ml，检测WBC、hs-CRP及PCT水平，用诊断试验四格表分析VEEG在早产儿脑损伤诊断中的灵敏度、特异度，用重复测量方差分析比较两组间不同时间点WBC、hs-CRP及PCT水平差异。结果　VEEG诊断脑损伤的灵敏度为78.6%（22/28），特异度为82.1%（23/28），阳性预测值为81.5%（22/27），阴性预测值为79.3%（23/29），阳性似然比为4.4，阴性似然比为3.8，准确率为80.4%，Kappa值为0.607。生后第1天，两组hs-CRP水平差异无统计学意义（P>0.05），WBC和PCT水平脑损伤组高于无脑损伤组（均P<0.05）；生后第3天，脑损伤组的WBC、hs-CRP及PCT值均高于无脑损伤组（均P<0.05）；生后第7天，两组的WBC、PCT值差异均无统计学意义（均P>0.05），而脑损伤组的hs-CRP值更高（P<0.05）。结论　VEEG可作为早产儿脑损伤早期诊断较可靠依据，生后第3天的WBC、hs-CRP及PCT水平同时升高时常提示早产儿有脑损伤风险。

关键词: 早产儿, 脑损伤, 视频脑电图, 白细胞总数, 超敏C反应蛋白, 降钙素原