Математичний аналіз оцінки рівня гомоцистеїну в сироватці крові як предиктора розвитку менінгіту в новонароджених із гіпоксично-ішемічним ураженням центральної нервової системи

Abstract

The main reason for the development of neonatal hypoxic-ischemic encephalopathy is inadequate oxygen supply to brain tissue, due to a combination of hypoxemia and ischemia. Hypoxia leads to disruption of oxidative processes and the development of acidosis, decreased energy balance of the cell, an excess of excitatory neurotransmitters, impaired metabolism of glia and neurons. Excess homocysteine can also induce a cascade of events in hippocampal neurons, producing in response to acute bacterial meningitis and accumulating in the central nervous system, reaching neurotoxic levels. Understanding the pathological mechanisms of neonatal ischemic Brain injury will help optimize treatment and reduce the degree of hypoxic-ischemic damage. The purpose of the study was to assess the level of homocysteine in the blood serum as a predictor of the development of meningitis in newborns with hypoxic-ischemic lesions of the central nervous system using mathematical analysis. Material and methods. The following research methods were used in the course of work: clinical-anamnestic (subjective and objective examination data), laboratory (biochemical, immunological method, enzyme-linked immunosorbent assay method), instrumental (neurosonography), methods of mathematical statistics. Statistical processing of all obtained results performed on a personal computer using the license software package Statistics 13.0 (StatSoftInc, serial number JPZ8041382130ARCN10-J) and MS Excel. We used the following methods of statistical analysis in the study: descriptive statistics, parametric and nonparametric methods of comparison of mean groups, correlation analysis, multiple linear and logistic regression analysis, utility statistics: odds ratio, relative risk, ROC analysis. Results and discussion. The relationship between homocysteine and hemoglobin and gestational age was found to be direct and reversed with bilirubin. The use of linear regression analysis allowed predicting the value of homocysteine by known values of one or more predictor variables. A ROC analysis was performed to assess the diagnostic significance of homocysteine levels as an indicator of oxidative stress and to express it in some integral indicators. Conclusion. The analysis showed that high levels of homocysteine in newborns can be considered as a statistically significant indicator of oxidative stress and a predictor of meningitis in premature infants. The probability of developing meningitis in premature infants with high homocysteine levels is 1.15 times higher than in full-term infants with central nervous system lesions (p> 0.05) and 8 times higher (p <0.05) than in full-term relatively healthy infants