新生儿缺氧缺血性脑病血浆及脑脊液乳酸的临床研究

Lactate levels in plasma and cerebrospinal fluid of neonates with hypoxic2ischemic encephalopathy

摘要:

目的 围产期窒息是引起新生儿脑损伤的重要原因之一 ,目前仍无确切的方法早期预测其预后。本实验研究缺氧缺血性脑病 (HIE)患儿血浆和脑脊液 (CSF)乳酸 (Lac)的变化 ,观察Lac与HIE及窒息的关系。方法 对 2 6例HIE患儿 (轻度 8例 ,中度 10例 ,重度 8例 )和 8例正常对照组 ,在生后 0～ 2 4h、4 8～ 72h及 7～ 10d抽取动脉血测Lac含量 ,HIE患儿生后 4 8～ 72h腰穿取CSF测Lac含量 ,并于生后 7～ 10d做头部MRI检查。结果 对照组和病例组血浆Lac均随日龄增加呈下降趋势 ,有统计学差异。生后 0～ 2 4h ,4 8～ 72hHIE组血浆Lac较对照组显著升高 (均P <0 .0 1)。重度HIE组血浆Lac(9.11± 3.2 9mmol/L)与轻、中度HIE组 (6 .0 3±2 .6 6mmol/L ,6 .5 6± 1.4 2mmol/L)相比较仅在 0～ 2 4h明显升高 (均P <0 .0 5 )。重度组CSFLac(2 .5 3±0 .2 7mmol/L)与轻、中度HIE(1.80± 0 .2 0mmol/L ,1.91± 0 .2 8mmol/L)相比有显著增高 (均 P <0 .0 1)。 5minApgar评分≤ 5分组CSFLac含量 (2 .4 3± 0 .34mmol/L)较 >5分组 (1.83± 0 .2 5mmol/L)明显升高 (t =5 .2 2 ,P<0 .0 1)。重度MRI改变的HIE患儿CSFLac较轻、中度MRI改变的HIE患儿CSFLac明显升高 (2 .36±0 .4 4mmol/Lvs 1.72± 0 .2 4mmol/L ,2 .14± 0 .2 6mmol/L

Abstract:

Objective Perinatal asphyxia is an important cause of brain injury, but an early prediction of outcome is still difficult. This paper aims to study the changes of lactate levels in plasma and cerebrospinal fluid (CSF) of neonates with hypoxic-ischemic encephalopathy (HIE) so as to explore the relationship between lactate levels and HIE as well as asphyxia. Methods Plasma lactate levels were measured in 26 neonates with HIE (8 mild, 10 moderate and 8 severe cases) and 8 healthy neonates at 0-24 hrs, 48-72 hrs and 7-10 days of their lives. CSF lactate levels were measured at 48-72 hrs of their lives and brain MRI examination was taken 7-10 days after birth in neonates with HIE. Results Plasma lactate levels in neonates with HIE and healthy neonates decreased daily after birth. The plasma lactate levels of the HIE neonates were significantly higher than those of the healthy ones at 0-24 hrs and 48-72 hrs of their lives. Plasma lactate levels in severe HIE neonates ( 9.11± 3.29 mmol/L) were higher than those of neonates with mild and moderate HIE ( 6.03± 2.66 and 6.56± 1.42 mmol/L) in the first day after birth (P< 0.05), but not in the following days. The CSF lactate levels in the severe HIE neonates ( 2.53± 0.27 mmol/L) were significantly higher than those in mild and moderate HIE ones ( 1.80± 0.20 and 1.91± 0.28 mmol/L) (P< 0.01). CSF lactate levels in the asphyxiated neonates whose 5 min Apgar score were less than 5 scores ( 2.43± 0.34 mmol/L) were higher than those whose Apgar scores were more than 5 ( 1.83± 0.25 mmol/L) (t= 5.22,P< 0.01). CSF lactate levels in HIE neonates with severe MRI abnormalities were higher than those with mild and moderate ( 2.36± 0.44 mmol/L vs 1.72± 0.24 mmol/L, 2.14± 0.26 mmol/L) (F= 7.15, P< 0.01). Conclusions The plasma lactate level may be associated with the degree of hypoxia only in the first 24 hrs of life. The CSF lactate level can reflect the severity of brain injury.