三七皂甙治疗新生儿缺氧缺血性脑病的临床研究

Clinical Study on Panax Notoginseng Saponins in the Treatment of Neonatal Hypoxic Ischemic Encephalopathy

摘要:

目的：探讨三七皂甙对脑细胞的保护作用。方法：用新型钙染色剂Indo—1/Am检测缺氧缺血性脑病(HIE)患儿三七皂甙治疗前后细胞内钙变化,观察三七皂甙对细胞内钙超载的拮抗作用。将HIE患儿分为治疗组24例,对照组18例,同时设正常对照10例。在传统治疗的基础上,治疗组加用三七皂甙5～8 d,分别于入院时、治疗后24 h、72 h检测各组红细胞内游离钙(RBC[Ca2+]i)的浓度变化。结果：HIE治疗组及对照组RBC[Ca2+]i较正常足月儿升高,差异有非常显著性意义(P<0.01),HIE治疗组与HIE对照组比较,RBC[Ca2+]i在治疗前无明显差异(P>0.05),治疗后随着缺氧缺血状态的改善,检测48 h、72 h RBC[Ca2+]i,治疗组RBC[Ca2+]i明显下降,差异有显著性意义(P<0.01),HIE治疗组自身比较,RBC[Ca2+]i在治疗72 h后明显下降,差异有显著性意义[(2.619±0.175)vs(2.358±0.280);P<0.01]。治疗组中枢性呼吸衰竭、循环不良、胃肠功能紊乱治疗的有效率分别为100.0％(5/5)、83.3％(20/24)、91.7％(22/24),对照组有效率分别为20.0％(1/5)、33.3％(6/18)、16.7％(3/18),(P<0.01)。结论：三七皂甙能缓解细胞内钙超载,保护脑组织,改善临床症状。

Abstract:

OBJECTIVE: To study whether Panax Notoginseng Saponins (PNS) has a protective effect on brain cells in neonates with hypoxic-ischemic encephalopathy (HIE). METHODS: Forty-two neonates with HIE were randomly assigned into the treatment group (n = 24) and the control group (n = 18). Ten normal neonates served as a reference group In addition to conventional therapy, the treatment group received PNS, 12-15 mg/kg daily for 5-8 days. Concentrations of intra-erythrocytic free calcium (RBC [Ca2+ ]i) in the three groups were assayed by a new staining calcium agent Indo-1/Am at the time of admission (before the treatment), and 48 hours and 72 hours after the treatment. RESULTS: Before the treatment, RBC [Ca2+ ]i concentrations in the HIE treatment group and control group were significantly higher than that of the normal non-HIE reference group ( P < 0.01); and there was no obvious difference between the two HIE groups. RBC [Ca ]i concentration in the PNS group obviously decreased at 48 hours and 72 hours after the PNS treatment compared with the control HIE group ( P <0.01). A significant difference was found in the RBC [Ca2+ ]i concentration in the; PNS group before and after the PNS treatment for 72 hours [(2.619 ± 0.175) vs (2.358 ±0.280); P <0.01]. PNS treatment significatly reduced central respiratory failure (20% vs 100%), circulatory dysfunction (33.3% vs 83.3%) and gastrointestinal symptoms (16.7% vs 91.7%) compared to the non-treated HIE group. CONCLUSIONS:Treatment with PNS improves the clinical symptoms in neonates with HIE. The mechanism of this neuro-protective effect may involve the reduction of intra-ery throcyte free calcium overload.