头部亚低温对新生儿缺氧缺血性脑病半胱氨酸蛋白酶-3和白介素-18的影响

Effects of selective head cooling with mild hypothermia on serum levels of caspase-3 and IL-18 in neonates with hypoxic-ischemic encephalopathy

摘要:

目的：探讨选择性头部亚低温治疗新生儿缺氧缺血性脑病(HIE)半胱氨酸蛋白酶-3(caspase-3)和白介素-18(IL-18)的变化，以了解头部亚低温治疗HIE的神经保护机制。方法：33例中、重度HIE患儿随机分为亚低温治疗组（n=16）和常规治疗组（n=17）。应用ELISA法检测0 h、24 h、48 h、72 h和5 d的外周血清中caspase-3和IL-18 的浓度。结果：亚低温组在治疗后24 h及48 h血浆caspase-3浓度分别为3.8±1.9和2.6±1.2 ng/mL,明显低于常规组的6.1±2.3和7.2±3.1 ng/mL，P<0.01。亚低温组血浆IL-8浓度在治疗后24 h、48 h及72 h亦出现明显下降，分别为119±30、76±33和71±40 ng/mL，与常规组的138±28、156±60和182±54 ng/mL相比，差异有统计学意义（P<0.01）。结论：应用头部亚低温治疗可抑制患儿血清中caspase-3和IL-18浓度的过度升高，揭示了头部亚低温治疗HIE的部分神经保护机制。［中国当代儿科杂志，2010，12（9）：690-692］

Abstract:

OBJECTIVE: The study examined the changes of serum caspase-3 and IL-8 levels following selective head cooling with mild hypothermia (SHC) treatment in neonates with hypoxic-ischemic encephalopathy (HIE) in order to explore the mechanism of neuroprotection of SHC against HIE. METHODS: Thirty-three neonates with moderate or severe HIE were randomly assigned to two groups: SHC treatment (n=16）and conventional treatment (n=17). Serum levels of caspase-3 and IL-18 were measured using ELISA before treatment and 24 hrs, 48 hrs, 72 hrs and 5 days after treatment. RESULTS: Serum caspase-3 levels in the SHC group decreased 24 and 48 hrs after treatment (3.8±1.9 and 2.6±1.2 ng/mL, respectively) compared with 6.1±2.3 ng/mL at 24 hrs and 7.2±3.1 ng/mL at 48 hrs in the conventional treatment group (P<0.05). Serum IL18 levels in the SHC group decreased 24 hrs, 48 hrs and 72 hrs after treatment (119±30, 76±33 and 71±40 ng/mL, respectively) compared with those in the conventional treatment group (138±28 ng/mL at 24 hrs, 156±60 ng/mL at 48 hrs and 182±54 ng/mL at 72 hrs; P<0.01). CONCLUSIONS: SHC treatment can inhibit the release of caspase-3 and the expression of IL-18 in neonates with moderate or severe HIE. This may contribute to the neuroprotection of SHC against HIE.［Chin J Contemp Pediatr, 2010, 12 (9):690-692］