单唾液酸四己糖神经节苷脂联合重组人促红细胞生成素治疗新生儿缺氧缺血性脑病疗效观察  

Efficacy of monosialotetrahexosyl ganglioside combined with recombinant human erythropoietin in the treatment of neonates with hypoxic-ischemic encephalopathy

作　　者：张靖[1] 任亚方 王岩[1] 王品 王越[1] ZHANG Jing;REN Yafang;WANG Yan;WANG Pin;WANG Yue(Department of Neonatology,Nanyang Central Hospital,Nanyang 473009,Henan Province,China)

机构地区：[1]南阳市中心医院新生儿科,河南南阳473009

出　　处：《新乡医学院学报》2024年第9期857-861,共5页Journal of Xinxiang Medical University

基　　金：2019年河南省医学科技攻关计划联合共建项目(编号:LHGJ20191453)。

摘　　要：目的探讨单唾液酸四己糖神经节苷脂(GM1)联合重组人促红细胞生成素(rhEPO)治疗新生儿缺氧缺血性脑病(HIE)临床疗效及其对炎症因子和神经功能的影响。方法选择2017年6月至2020年6月南阳市中心医院新生儿科收治的78例HIE患儿为研究对象,采用随机数字表法将患儿分为对照组(n=39)和观察组(n=39)。所有患儿给予常规治疗,包括吸氧、维持水电解质酸碱平衡、控制惊厥与颅内压等治疗,中重度患儿给予亚低温治疗。对照组患儿在常规治疗基础上给予rhEPO 200 IU·kg^(-1),皮下注射,每周3次;观察组患儿在对照组基础上给予GM120 mg静脉滴注,每日1次。7 d为1个疗程,连续治疗4个疗程,中、重度患儿依据病情再治疗1~3个疗程。比较2组患儿治疗后的总有效率;于治疗前和治疗后14、28 d采用新生儿神经行为评分(NBNA)评估2组患儿的神经功能;治疗前和治疗后14、28 d,采用酶联免疫吸附法测定2组患儿血清白细胞介素-6(IL-6)、细胞间黏附分子-1(ICAM-1)、肿瘤坏死因子-α(TNF-α)、缺氧诱导因子-1α(HIF-1α)、神经元特异性烯醇化酶(NSE)水平。结果对照组和观察组患儿总有效率分别为69.23%(27/39)、94.87(37/39),观察组患儿治疗总有效率显著高于对照组(χ^(2)=8.705,P=0.003)。2组轻度患儿治疗总有效率均为100%;观察组中中、重度患儿总有效率显著高于对照组(χ^(2)=4.843、3.898,P=0.028、0.048)。2组患儿治疗前NBNA评分比较差异无统计学意义(P>0.05);2组患儿治疗后14、28 d NBNA评分显著高于治疗前(P<0.05);2组患儿治疗后28 d NBNA评分显著高于治疗后14 d(P<0.05)。观察组患儿治疗后14、28 d NBNA评分显著高于对照组(P<0.05)。治疗前2组患儿血清ICAM-1、IL-6、TNF-α、HIF-1α、NSE水平比较差异无统计学意义(P>0.05);2组患儿治疗后14、28 d血清ICAM-1、IL-6、TNF-α、HIF-1α、NSE水平显著低于治疗前(P<0.05);2组患儿治疗后28 d血清ICAM-1、IL-6、TNF-Objective To investigate the clinical effect of monosialotetrahexosyl ganglioside(GM1)combined with recombinant human erythropoietin(rhEPO)in treating neonates with hypoxic-ischemic encephalopathy(HIE)and its influence on inflammatory factors and neurological function.Methods A total of 78 neonates with HIE admitted to the Department of Neonatology of Nanyang Central Hospital from June 2017 to June 2020 were selected as the research subjects,and they were divided into the control group(n=39)and the observation group(n=39)by random number table method.All neonates were given routine treatment,including oxygen inhalation,maintenance of water,electrolyte and acid-base balance,control of convulsions and intracranial pressure,and moderate and severe HIE neonates were given mild hypothermia therapy on this basis.Neonates in the control group were given rhEPO 200 IU·kg^(-1) via subcutaneous injection on the basis of routine treatment,3 times a week.Neonates in the observation group were given GM120 mg intravenously once a day on the basis of the treatment of the control group.Seven days were taken as one course of treatment,and four courses of continuous treatment were taken.Moderate and severe HIE neonates were treated for 1-3 courses additionally according to their condition.The total effective rate of the two groups after treatment was compared.The neurological function of neonates in the two groups was evaluated by neonatal behavioral neurological assessment(NBNA)before,14 and 28 days after the treatment.The interleukin-6(IL-6),intercellular adhesion molecule-1(ICAM-1),tumor necrosis factor-α(TNF-α),hypoxia inducible factor-1α(HIF-1α)and neuron specific enolase(NSE)in the serum were measured by enzyme-linked immunosorbent assay before,14 and 28 days after the treatment.Results The total effective rate of treatment in the control group and the observation group was 69.23%(27/39)and 94.87%(37/39),respectively;the total effective rate of the observation group was significantly higher than that in the control group

关 键 词：重组人促红细胞生成素 单唾液酸四己糖神经节苷脂 新生儿 缺氧缺血性脑病 缺氧诱导因子-1Α 神经元特异性烯醇化酶 

分 类 号：R747.9[医药卫生—神经病学与精神病学]