亚低温对中、重度新生儿缺氧缺血性脑病患儿血清髓鞘碱性蛋白、肿瘤坏死因子α水平及预后的影响研究  

Effect of Mild Hypothermia on Serum Levels of Myelin Basic Protein and TNF-αand Prognosis in Children with Moderate to Severe Neonatal Hypoxic-ischemic Encephalopathy

作　　者：王秋丽[1] 吕红艳[1] 吴素静[1] 宋俊霞[1] 李军勤 霍海花 任朋顺[1] WANG Qiuli;LYU Hongyan;WU Sujing;SONG Junxia;LI Junqin;HUO Haihua;REN Pengshun(Department of Neonatology,Handan Maternal and Child Health Care Hospital,Handan 056001,China)

机构地区：[1]河北省邯郸市妇幼保健院新生儿科,056001

出　　处：《实用心脑肺血管病杂志》2020年第8期47-52,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河北省卫生和计划生育委员会研究项目(20150033);河北省科技厅重点研发计划自筹项目(172777209)。

摘　　要：背景亚低温已被推荐作为治疗中、重度新生儿缺氧缺血性脑病(NHIE)的方法之一,然而其神经保护机制仍不十分清楚。目的探讨亚低温对NHIE患儿血清髓鞘碱性蛋白(MBP)、肿瘤坏死因子α(TNF-α)水平及预后的影响。方法选择2015年1月—2017年6月邯郸市妇幼保健院新生儿重症监护病房(NICU)收治的中、重度NHIE患儿88例为研究对象。按照家属是否同意接受亚低温治疗,将患儿分为亚低温组52例和对照组36例。对照组给予常规治疗;亚低温组除常规治疗外,于患儿出生后0~6 h给予选择性头部亚低温(SHC)治疗,两组患儿均治疗14~28 d。分别于治疗前和治疗后3d,采用酶联免疫吸附试验测定患儿血清MBP、TNF-α水平;记录患儿预后指标,包括神经发育结局[采用发育商(DQ)评估,分为神经发育迟缓、边缘状态、神经发育良好]和死亡情况。结果治疗后,亚低温组血清MBP、TNF-α水平低于对照组(P<0.05);亚低温组治疗后血清MBP、TNF-α水平分别低于本组治疗前(P<0.05)。亚低温组血清MBP、TNF-α水平均与DQ呈负相关(r值分别为-0.832、-0.876,P值均<0.001);亚低温组血清MBP水平与TNF-α水平呈正相关(r=0.836,P<0.001)。亚低温组神经发育结局优于对照组(P<0.05)。结论亚低温可降低中、重度NHIE患儿血清MBP、TNF-α水平,从而保护患儿中枢神经髓鞘免受损伤,且患儿预后良好,值得临床推广应用。Background Mild hypothermia has been recommended for moderate/severe neonatal hypoxia-ischemic encephalopathy(NHIE),but its neuroprotective mechanism is still not very clear.Objective To investigate the effect of mild hypothermia on serum myelin basic protein(MBP)and tumor necrosis factor-α(TNF-α)as well as the prognosis in children with moderate to severe NHIE.Methods A total of 88 children with moderate to severe NHIE who were admitted to the Neonatal Intensive Care Unit(NICU)of Handan Maternal and Child Health Hospital from January 2015 to June 2017 were selected as the research subjects.According to whether family members agreed to receive mild hypothermia treatment,the children were divided into mild hypothermia group 52 cases and control group 36 cases.The control group was given conventional treatment,the mild hypothermia group was given selective head cooling(SHC)treatment from 0 to 6 h after birth in addition to conventional treatment,both groups were treated for 14-28 days.Serum MBP and TNF-αlevels were measured by EMISA before treatment and 3 days after treatment,respectively;the prognosis indexes of the children were recorded,including neurodevelopmental outcomes[assessed by the development quotient(DQ),divided into neurodevelopmental retardation,marginal status,and good neurodevelopment]and death.Results After treatment,the serum MBP and TNF-αlevels in the mild hypothermia group were lower than those in the control group(P<0.05);in the mild hypothermia group,the levels of serum MBP and TNF-αafter treatment were lower than those before treatment(P<0.05).Serum MBP and TNF-αlevels were negatively correlated with DQ in the mild hypothermia group(r value was-0.832,-0.876,P<0.001);in the mild hypothermia group,there was a significant positive correlation between serum MBP levels and TNF-αlevels(r=0.836,P<0.001).The neurodevelopmental outcomes of the mild hypothermia group were better than those of the control group(P<0.05).Conclusion Mild hypothermia can reduce the serum MBP and TNF-αlevels in chil

关 键 词：缺氧缺血 脑 新生儿缺氧缺血性脑病 亚低温 髓鞘碱性蛋白 肿瘤坏死因子Α 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]