缺氧缺血性脑病患儿脑血流动力学调节中免疫细胞因子的作用及其机制(英文)

Function and mechanism of cytokines in cerebral hemodynamic regulation in neonatal hypoxica-ischemic encephalopathy

背景:细胞因子对脑血流动力学的调节作用是否通过调节血浆内皮素-1(endothelin-1,ET-1)、降钙素基因相关肽(calcitoningene-relatedpep-tide,cGRP)、C型利钠肽(C-typenatriureticpeptide,CNP)等血管活性因子的变化而实现的。目的:探讨细胞因子对缺氧缺血性脑病(hypoxic-ischemicencephalopa-thy,HIE)患儿脑血流动力学的调节作用及其机制。设计:非随机对照实验研究。地点、材料和干预:研究对象为1999-05/2001-06来源于首都医科大学附属北京妇产医院,用放射免疫法检测40例HIE患儿与40例正常新生儿生后1,3,和7d外周血白细胞介素-6(interleukin-6,IL-6),肿瘤坏死因子-α(tumornecrosisfactor-alpha,TNF-α),白细胞介素-8(interleukin-8,IL-8)与内皮素-1(endothelin-1,ET-1)、降钙素基因相关肽(calcitoningene-relatedpeptide,cGRP)、C型利钠肽(C-typenatriureticpeptide,CNP)水平,由北京东亚免疫技术研究所负责检测。于生后第1天用脉冲多普勒超声检测两组新生儿大脑中动脉的血流动力学参数。结果:HIE患儿血清TNF-α升高、IL-6、IL-8降低,并与脑血流动力学紊乱和ET-1,cGRP,CNP的变化具有一定相关性,即阻力指数(RI)与IL-6呈负相关(r=-0.61,P<0.01),与IL-8,TNF-α呈正相关(r=0.80,0.72,P<0.01)。

BACKGROUND:Whether the cerebral hemodynamic regulation by immune cell factors can be carried out through adjusting vascular active factors such as endothelin -1(ET-1),calcitonin gene-related peptide(cGRP),and C-type natriuretic peptide(CNP). OBJECTIVE:To explore the function and mechanism of cytokines in cerebral hemo dynamic regulation in neonates with hypoxic-ischemic encephalopathy(HIE). DESING:Non-randomized controlled trial. SETTING,MATERIALS and INTERVENTIONS:The subjects were selected from Beijing Ob stetrics & Gynecology Hospital Affiliated to Capital University of Medical Scien ces from May 1999 to June 2001.Levels of peripheral blood interleukin-6(IL-6), tumor necrosis factor-alpha(TNF-α),interleukin-8(IL-8),endothelin-1(ET-1) ,calcitonin gene-related peptide(cGRP),and C-type natriuretic peptide(CNP)in 40 hypoxic-ischemic encephalopathy(HIE) and 40 healthy neonates were detected o n the 1st,3rd,and 7th days after birth using radioimmunoassay by Dongya Immunolo gical Technology Institute,Beijing.Hemodynamic parameters of middle cerebral art eries in the two groups were measured by pulse Doppler on the first day of birth . RESULTS:In HIE group plasma level of TNF-|áwas increased and IL-6 and IL-8 level was decreased,which correlated with disturbed cerebral hemodynamics and c hanges in ETa21,CGRP,and CNP levels.To be specific,resistance index(RI) was nega tively correlated with ILa26 level(r=￡-0.61￡P< 0.01),and positively correlated with ILa28 and TNFa2|á(r=0.80, 0.72,P< 0.01).ILa26 had negative correlation with ETa21￡¨r=￡-0.54￡P< 0.01￡?￡and positive correlation with CNP and cGRP(r=0.49￡ 0.52￡P< 0.01).By contrast,ILa28 and TNFa2|áwere positively correlated with ETa2 1(r=0.61￡0.72￡P< 0.01) and negatively correlated with CNP and CGRP(r=￡-0.51￡ ￡-0.63￡P< 0.01). a$CONCLUSION￡oPlasma levels of ILa26,ILa28 and TNFa2|áfollowing HIE in neonates may regulate cerebral hemodynamics by adjusting the changes of ETa21,CGRP and CN P￡thus participating in pathophysiologic mechanism of HIE.