缺氧缺血性脑病新生儿血浆脑利钠肽的动态变化及其临床意义  

Clinical significance of plasma brain natriuretic peptide in the newborn with hypoxia-ischemic encephaiopathy

作　　者：张玮[1] 翟敏[1] 李先清[1] 廖廷彦[1] 余霞[1] 李晓玲[1] 刘成忠[1] 贺思[1] 兰安云[1] 

机构地区：[1]湖北省枣阳市第一人民医院儿科,441200

出　　处：《中华围产医学杂志》2007年第2期91-95,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的动态观察缺氧缺血性脑病（hypoxia—ischemic encephalopathy，HIE）新生儿血浆脑利钠肽（brain natriuretic peptide，BNP）变化规律及其与血钠、新生儿行为神经测定的关系。方法124例HIE患儿，血钠低于130mmol／L者36例为低血钠组，88例为血钠正常组；另选取非HIE、足月、体重正常、血钠正常者38例为对照组。比较三组患儿出生第3、7、14天血浆BNP水平。比较低血钠组和血钠正常组新生儿行为神经测定（neonatal behavioral neurological assessment，NBNA）结果及跟踪观察52周的发育商数（developmental quotient，DQ），并分析血浆BNP与血清钠、NBNA评分的相关性。结果生后第3天，124例HIE患儿血浆BNP为（0．612±0．11）ng／ml，明显高于对照组（t=2．296，P〈0．05）；低血钠组明显高于血钠正常组（q=7．70，P=0．000）及对照组（q=9．04，P=0．000）。生后3、7、14d时，血钠正常组NBNA评分均高于低血钠组，低血钠组患儿NBNA评分从生后第3天至第14天逐渐升高（P均＜0．01）。在28周以前（含28周），低血钠组与血钠正常组的大运动、精细运动、适应能力、语言和社会交往5个方面比较差异均有统计学意义（P均＜0．05）。在52周时，两组大运动、精细运动、语言和社会交往4个方面差异有统计学意义（P均＜0．05）。在出生后3、7、14d时，低血钠组血浆BNP水平与血清钠浓度呈负相关（r分别为-0．762、-0．671、-0．735，P均〈0．01）；血清钠与NBNA评分呈正相关（r分别为0．695、0．570、0．538，P均＜0．01）。结论BNP可能参与和导致了HIE患儿的低钠血症，并直接和经过低钠介导在HIE病理过程中发挥重要作用。动态监测血浆BNP浓度可以作为判断病情、评价疗效和预测预后的指标。Objective To study the change of the concentration of plasma brain natriuretic peptide （BNP） in the newborn with hypoxia-ischemic encephalopathy（HIE）and its relationship with neonatal behavioral neurological assessment （NBNA）and the plasma natrium level. Methods One hundred and sixty two infants were involved in this study and were divided into three groups. Low natrium group included 36 infants with HIE whose natrium level were lower than 130 mmol/L; Normal natrium group included 88 infants with HIE whose natrium level were higher than 130 mmol/L; Control group included 38 normal term birth infants. Plasma BNP and natrium level of them were detected at the age of 3 days, 7 days and 14 days and were compared between three groups. The NBNA was compared between the low natrium group and normal natrium group. The developmental quotient of infants was followed up for 52 weeks. Results BNP of infants with HIE at the age of 3 days [（0. 612 ±0. 11）ng/ml] was significantly higher than that of the control group [（0.23±0.06）ng/ml], P〈 0.05; And BNP of low natrium group at the age of 3 days was higher than that of normal natrium group（q=7.70,P=0.000） and control group （q=9.04,P=0.000）. The NBNA of low natrium group was gradually increased during fourteen days after birth, and was lower than that of normal natrium group. There were statistical differences between the gross, accurate movements, the abilities of adaptation, speech, social activities of normal natrium group and low natrium group before the age of 28 week and 52 week （P〈0. 05, respectively）, except that the adaptation ability of two groups are similar at the age of 52 week. In the low natrium group during the two weeks after birth, plasma natrium had negative correlation with BNP, and had positive correlation with NBNA （P〈0.01 ,respectively）. Conclusions BNP might participate and result in the hyponatremia and played an important role in the development of HIE. The plasma BNP might be an important index for the disease

关 键 词：婴儿 新生 缺氧缺血 脑 利钠肽 脑 儿童发育 

分 类 号：R742[医药卫生—神经病学与精神病学]