新生儿缺氧缺血性脑病血清及脑脊液中促红细胞生成素的变化(英文)

Erythropoietin levels in serum and cerebrospinal fluid of neonates with hypoxic-ischemic encephalopathy

摘要:

目的：探讨缺氧缺血性脑病(HIE)患儿血清和脑脊液(CSF)中促红细胞生成素（Epo）的变化，观察Epo与脑损伤的关系。方法：对26例HIE患儿（轻度8例，中度10例，重度8例）和8例正常对照组进行研究，在生后0~24 h、48~72h 及7~10 d抽取静脉血，HIE组在生后48~72 h腰穿取CSF，放射免疫法测定血清和CSF Epo含量，HIE组生后7~10d做头部MRI检查。结果：对照组血清Epo随日龄增加呈下降趋势，有统计学差异(P<0.05)；HIE各组血清Epo水平呈先上升而后下降趋势，其中仅轻度组血清Epo变化显著(P<0.05)；各时间段重度组较轻度组、对照组血清Epo明显升高，有统计学差异。重度HIE组较轻、中度组CSF Epo明显升高(F=6.86,P<0.01)。重度HIE组48~72 hr血清与CSF Epo水平有较强直线相关关系( r = 0.76, P < 0.05)；而轻、中度HIE组血清与CSF Epo无直线相关关系(r = 0.12, r = 0.09, P > 0.05)。头部MRI为重度改变的HIE患儿CSF中Epo水平均较头部MRI为轻、中度改变的HIE患儿显著升高(F = 8.56, P < 0.01)。结论：HIE患儿血清Epo显著升高，持续不降是病情危重的标志。CSF中Epo显著升高提示HIE患儿脑损伤严重，预后不良。重度HIE患儿可能存在着血脑屏障的破坏，Epo可能透过血脑屏障。［中国当代儿科杂志，2005, 7(2): 107-111］

Abstract:

OBBJECTIVE: To observe the changes of erythropoietinerythrogenin (Epo) in serum and cerebrospinal fluid (CSF) in neonates with hypoxic-ischemic encephalopathy (HIE), and to study the relationship between Epo levels and brain injury. METHODS: Serum Epo levels were measured by radioimmunoassay in 26 neonates with HIE (HIE group, 8 mild, 10 moderate and 8 severe ) and 8 normal neonates (Control group) at 0-24 hrs, 48-72 hrs and 7-10 days of their lives. CSF Epo levels were measured at 48-72 hrs of their lives and brain MRI scans were taken 7-10 days after birth in the HIE group. RESULTS: In the Control group, serum Epo levels decreased significantly within days after birth (P<0.05); However, in the HIE group serum Epo levels increased during 1-3 days then decreased thereafter; Significantly decreased levels were observed only in mild HIE neonates ( P< 0.05). In every time period, the serum Epo concentration in severe HIE neonates was significantly higher than in mild and moderate HIE neonates. It was also observed that CSF Epo levels in severe HIE neonates were significantly higher than those of mild and moderate HIE neonates (P<0.01). There was a significant linear and positive correlation between serum and CSF Epo levels at 48-72 hrs in severe HIE neonates (r= 0.76, P< 0.05), but not in mild and moderate HIE neonates. CSF Epo levels in neonates with severe cranial MRI abnormalities were significantly higher than those of neonates with mild and moderate cranial MRI abnormalities (P< 0.01). CONCLUSIONS: The maintained and increased serum Epo levels may be a marker of severe hypoxic-ischemia in neonates with HIE. CSF Epo levels can reflect the severity of cerebral hypoxia-ischemia; Impaired blood-brain barrier might account for the increased CSF Epo levels.