新生儿缺氧缺血性脑病血NSE与ET变化及其与高压氧治疗相关性的研究

Dynamic Changes of Blood NSE and ET in Infants with HIE Treated by Hyperbaric Oxygen

摘要:

目的 探讨肿瘤坏死因子-α(TNF-α)和降钙素基因相关肽(CGRP)在新生儿缺氧缺血性脑病(HIE)中的变化及临床意义。方法 采用放射免疫分析法对38例HIE患儿和18例健康足月新生儿血浆TNF-α与CGRP水平进行了同期动态观察。结果 HIE患儿急性期TNF-α，CGRP水平分别为(1.12±0.42) ng/ml，(88.92±23.16) ng/ml；恢复期分别为(0.61±0.18) ng/ml，(68.39±19.32) ng/ml；对照组分别为(0.54±0.15) ng/ml，(66.2±14.54) ng/ml。急性期血浆TNF-α和CGRP水平较恢复期显著增高(P<0.01)，并明显高于同期对照组水平(P<0.01)，恢复期与正常对照组无显著差异，急性期不同程度HIE与对照组TNF-α，CGRP水平比较，重度HIE组TNF-α，CGRP分别为(1.28±0.41) ng/ml，(118.12±30.25) ng/ml；中度HIE组分别为(0.95±0.3) ng/ml，(86.49±24.36) ng/ml，轻度HIE组分别为(0.63±0.19) ng/ml，(68.31±18.38) ng/ml，重度组明显高于对照组、轻度组及中度组，中度组高于对照组和轻度组，轻度组与对照组无显著性差异。急性期患儿血浆TNF-α与CGRP呈直线正相关关系(r=0.513，P<0.05)。结论 TNF-α和CGRP参与了新生儿HIE的发病过程。急性期TNF-α的增高可能是促发HIE脑损伤的一个重要因素，而CGRP增高在HIE中对脑损伤可能具有一定的保护作用。

Abstract:

Objective To explore the therapeutic effects of hyperbaric oxygen on neonatal hypoxic - ischemic encephalopathy (HIE) and its potential mechanism. Methods The serum neuron specific enolase (NSE) were tested by ELISA and plasma endothlin (ET) were detected with radio - immune - assay (RIA) before and after hyperbaric oxygen therapy. Results The serum NSE and plasma ET were (14. 72 ± 4. 26)μg/L and (76. 1 ± 19. 2) ng/L in the moderate group respectively and (15. 64 ± 5. 82) μg/L and (82. 5 ± 21. 6) ng/L in the severe group respectively. The NSE and ET were increased significantly in the moderate group and the severe group as compared with the control group (12. 47 ± 3. 49 μg/L,56. 32 ± 16. 7 ng/L respectively); The NSE and ET were (13. 58 ± 4. 57) μg/L and (62. 4 ± 18. 5) ng/L. in the mild group respectively and not increased significantly with the control group. The level of NSE and ET significantly decreased after hyperbaric oxygen was engaged. Conclusions The serum NSE and plasma ET were a good discriminator for the evaluation of HIE, and its dynamic changes might be one of the potential mechanisms for the therapeutic effects of hyperbaric oxygen on HIE.