新生儿缺氧缺血性脑病血浆及脑脊液血管内皮生长因子和一氧化氮的变化

Changes of vascular endothelial growth factor and nitric oxide levels in plasma and cerebrospinal fluid in newborns with hypoxic-ischemic encephalopathy

目的 观察新生儿缺氧缺血性脑病 (HIE)血浆与脑脊液 (CSF)中血管内皮生长因子 (VEGF)与一氧化氮 (NO)含量的变化及与HIE严重程度的关系。方法 检测 38例HIE患儿 (轻度 16例 ,中度 13例 ,重度 9例 )早期 (生后 2 4h内 )血浆与CSF中VEGF与NO含量 ,并与 13例非神经系统疾病对照组比较。分析VEGF与NO的相关性及其意义。结果 中、重度HIE组CSF中NO含量 (12 .6 5± 1.4 4 μmol/L,14 .82± 1.91μmol/L)与对照组 (8.11± 1.33μmol/L)及轻度HIE组 (9.2 1± 1.74 μmol/L)相比显著升高 (均P <0 .0 1) ,且重度HIE组NO的含量大于中度HIE组 (P <0 .0 1) ,而轻度HIE组与对照组无显著性差异 ;轻、中、重度HIE患儿CSF中VEGF含量 (12 .30± 1.2 4 pg/ml,13.6 0± 0 .85 pg/ml,14 .79± 1.6 3pg/ml)均明显高于对照组 (10 .94± 1.4 8pg/ml) (P <0 .0 1) ,且VEGF含量随病情严重程度增加而增加。HIE患儿CSF中VEGF与NO的含量呈显著正相关 (r =0 .6 17,P <0 .0 1)。HIE各组血浆中VEGF与NO含量未见显著性差异。结论 VEGF在早期HIE患儿CSF中明显升高 ,检则CSFVEGF水平将可能有助于HIE的早期诊断及疾病严重程度的判断。

Objective To investigate the cerebrospinal fluid (CSF) and plasma vascular endothelial growth factor (VEGF) and nitric oxide (NO) levels in newborns with different degrees of hypoxic-ischemic encephalopathy (HIE) and to study the correlation between NO and VEGF. Methods CSF and plasma samples from 38 newborns with HIE (16 mild, 13 moderate and 9 severe) were obtained within the first 24 hours of life. CSF samples of 13 neonates without nervous system diseases were used as controls. The levels of VEGF and NO in CSF and plasma were measured by ELISA and nitrate reduction respectively. The correlation between VEGF and NO was analyzed by Pearson correlation analysis. Results The CSF NO levels in the moderate and severe HIE neonates ( 12.65± 1.44 and 14.82± 1.91 μmol/L) were higher than those of the controls ( 8.11± 1.33 μmol/L) and the mild HIE neonates ( 9.21± 1.74 μmol/L) (P< 0.01). The highest CSF NO level was found in the severe HIE neonates, whereas that of the mild HIE neonates was similar to that of the controls. The CSF VEGF levels in the three HIE groups ( 12.30± 1.24, 13.60± 0.85 and 14.79± 1.63 pg/ml) were significantly higher than that of controls ( 10.94± 1.48 pg/ml) (P< 0.01). The more serious the disease, the higher the VEGF level. There was a significant positive correlation between VEGF and NO levels in the CSF of neonates with HIE (r= 0.617, P< 0.01). There were no significant differences in plasma VEGF and NO levels among the three HIE groups. Conclusions VEGF may be useful for early diagnosis and severity and prognosis evaluation of HIE.