新生儿缺氧缺血性脑病血管活性因子变化及其对脑血流动力学的影响  

The Changes of Vascular Actvating Factors in Neonatal Hypoxemic-Ischemic Encephalopathy and Its Influence on Cerebral Hemodynamics.

作　　者：刘敬[1] 曹海英[2] 邸英芬[3] 

机构地区：[1]首都医科大学附属北京妇产医院NICU,北京100026 [2]首都医科大学附属北京妇产医院GE医疗超声部,北京100026 [3]石家庄市第四医院,石家庄050011

出　　处：《中国儿童保健杂志》2003年第1期7-10,共4页Chinese Journal of Child Health Care

摘　　要：【目的】　研究新生儿缺氧缺血性脑病 (HIE)血浆内皮素 1(ET 1)、降钙素基因相关肽 (cGRP)、C型利钠肽 (CNP)、神经肽Y (NPY)、神经降压素 (NT)、一氧化氮 (NO)、白细胞介素 6(IL 6)、白细胞介素 8(IL 8)及肿瘤坏死因子 α(TNF α)等血管活性因子变化的临床意义及其对脑血流动力学的影响。　【方法】　分别用放射免疫法和硝酸盐还原酶两点法 ,检测 40例HIE患儿及 40例正常新生儿脐血及生后 1d、3d、7d外周血ET 1、cGRP、CNP、NPY、NT、NO、IL 6、IL 8及TNF α的动态变化 ;并于生后 2 4h内取外周静脉血后即刻应用脉冲多谱勒超声检测HIE患儿大脑中动脉的血流动力学参数。　【结果】　与正常新生儿相比 ,HIE患儿 :①血浆ET 1、cGRP、CNP、NPY与NT水平显著升高 ,IL 6降低 ;IL 8脐血升高 ,外周血降低 ;血浆NO降低 ,但呈逐渐升高趋势。②直线相关分析发现 ,脑血流阻力指数 (RI)与IL 6呈负相关 (r =-0 .61,P <0 .0 1) ,与IL 8、TNF α呈正相关 (r =0 .80、0 .72 ,P <0 .0 1) ;多元逐步回归分析表明上述血管活性因子中以ET 1、cGRP、CNP对脑血流动力学影响最大 (F =3 6.5 2 ,P <0 .0 1)。　【结论】　新生儿窒息后血浆ET 1、cGRP、CNP、NPY、NT、NO、IL 6、IL 8及TNF α等的变化参与了HIE的病理生理过程 。To study the variation of endothelin 1(ET 1),calcitonin gene related peptide(cGRP),C type natriuretic peptide(CNP),neuropeptide Y(NPY),neurotensin(NT),nitric oxide(NO),interleukin 6 (IL 6),Interleukin 8 (IL 8) and tumor necrosis factor alpha (TNF α)and their influence on cerebral arteries hemodynamics in neonatal hypoxemic ischemic encephalopathy(HIE). To observe the variation of ET 1,cGRP,CNP,NPY,NT,NO,IL 6,IL 8 and TNF α in cord blood and peripheral blood at 1 day,3 days and 7 days after birth in HIE infants and healthy controls by using radioimmuneassay and two point assay of nitrate reducatse,respectively. The cerebral artery hemodynamics were determined by using the color Doppler ultrasonography on the first day just after the blood samples were obtained. ①The serum ET 1,cGRP,CNP,NPY,NT,IL 8(in cord blood) and TNF α were significantly elevated and IL 6,IL 8 (in peripheral blood) were decreased in neonates with HIE.②Levels of NO was decreased in neonates with HIE.It was increasing gradually.③Linear regression has showed the resistance index (RI) negatively correlated with IL 6( r=-0.61,P <0.01),and positively correlated with IL 8 and TNF α( r =0.80,0.72,respectively, P <0.01),while multiple regression has showed that ET 1,cGRP and CNP have significant influence on cerebral arteries hemodynamics in neonates with HIE. [Conclusions] The imbalance of ET 1,cGRP and CNP in asphyxiated neonates was one of the main reasons of cerebral hemodynamic disturbance in HIE,and cytokines have a significant influence on cerebral hemodynamic disturbance.

关 键 词：缺氧缺血性脑病 血管活性因子 脑血流动力学 新生儿 

分 类 号：R722.12[医药卫生—儿科]