高压氧治疗新生儿缺氧缺血性脑病血清相关因子变化的探讨  

Changes of serum levels of related factors in hyperbaric oxygen therapy for neonates with hypoxic-ischemic encephalopathy

作　　者：刘海樱[1] 宋韶鸣[1] 徐英美[1] 

机构地区：[1]南京医科大学附属南京市儿童医院新生儿科,江苏省南京市210008

出　　处：《中国临床康复》2003年第16期2294-2295,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的了解高压氧(HBO)治疗中、重度新生儿缺氧缺血性脑病(HIE)后血清神经元特异性烯醇化酶(NSE)、血浆内皮素(ET)的变化,探讨高压氧治疗对新生儿HIE的保护作用。方法81例HIE患儿,其中15例为轻度组、66例为中重度,又将中重度HIE患儿随机分为高压氧治疗组(32例)、同期治疗对照组(34例)。另外12例为正常新生儿组。在治疗前后分别用酶联免疫分析法检测血清NSE、放射免疫分析法检测血浆ET。结果中重度HIE66例(高压氧治疗组和对照组)治疗前血清NSE犤分别为(15.4±4.2)和(16.3±5.1)μg/L犦、血浆ET水平犤分别为(80±16)和(78±19)ng/L犦,均高于轻度HIE组与正常新生儿组犤分别为(6.86±0.64)μg/L和(54.52±10.54)ng/L犦。治疗后两组NSE和ET明显降低,分别为(6.4±1.7)、(9.8±3.5)μg/L和(49±6)、(55±9)ng/L与各自治疗前相比差异亦有显著性意义(t=0.41～5.07,P<0.001),但高压氧治疗组血清NSE、血浆ET下降程度与对照组比较差异有显著性意义(t=9.31～13.18,P<0.001)。结论高压氧早期治疗中、重HIE可能通过降低ET水平,而减轻脑血管床的阻力,维持HIE损伤后脑的正常血流灌注,稳定细胞生成的内环境,减轻继发性脑损伤,达到脑保护作用。Aim To study the changes of serum neuron specific enolase (NSE) and plasma endothelins (ET) in neonates with moderate and severe hypoxic ischemic encephalopathy (HIE) before and after treatment with hyperbaric oxygen (HBO), and to discuss the protective effects of HBO on HIE in neonate. Methods Eighty one neonates with HIE, including 15 cases of mild HIE and 66 cases of severe and moderate HIE, were evaluated. Then the latter was randomly divided into two groups: treatment group treated with HBO (n=32) and control group (n=34). Twelve healthy neonates were used as controls (health group). The serum NSE with EIA and plasma ET with RIA before and after HBO treatment were detected by immunoassay and radioimmunoassay respectively. Results The concentrations of serum NSE were(15.4±4.2)μg/L and(16.3±5.1)μg/L before treatment in the HBO and control groups respectively, higher than those of the mild and health group[(6.86±0.64)μg/L]. The concentrations of plasma ET before treatment were(80±16)ng/L and(78±19)ng/L in the HBO and control groups respectively, higher than that of the mild and health groups[(54.52±10.54)ng/L].The concentrations of serum NSE and plasma ET after treatment were significantly reduced to (6.4±1.7)μg/L,(9.8±3.5)μg/L and(49±6)ng/L,(55±9)ng/L respectively in the two groups, with a significant difference between pre treatment and post treatment respectively in each group (t=0.41-5.07,P< 0.001). The descent degree of the concentrations of serum NSE and plasma ET in the HBO group was significantly different from that of the control group (t=9.31-13.18,P< 0.001). Conclusion Serum NSE and plasma ET are the better biochemical indicators for HIE. Early hyperbaric oxygen therapy has the protective effects on moderate and severe HIE by decreasing the concentration of ET.

关 键 词：高压氧治疗 新生儿 缺氧缺血性脑病 血清 神经元特异性烯醇化酶 血浆内皮素 

分 类 号：R722.12[医药卫生—儿科] R459.6[医药卫生—临床医学]