缺氧缺血性脑病新生儿血浆肾上腺髓质素／内皮素-1值与血清神经元特异性烯醇化酶的相关性

Relationship between the Ratio of Plasma Adrenomedullin/Endothelin-1 and Neuron-Specific Enolase in Full-Term Neonates with Hypoxic-Ischemic Encephalopathy

目的探讨缺氧缺血性脑病(HIE)足月新生儿血浆肾上腺髓质素(AM)/内皮素-1(ET-1)值的变化对血清神经元特异性烯醇化酶(NSE)的影响。方法2005年1-12月收治HIE新生儿32例。按照HIE的诊断标准分为轻度组18例,中重度组14例。本院同期出生的30例健康新生儿(生后24h)为健康对照组。采用放射免疫法动态测定HIE新生儿生后1、3、7d及健康新生儿生后1d血浆AM、ET-1和血清NSE水平。均数比较采用方差分析及S-N-K检验,双变量资料采用直线相关分析。结果1.轻、中重度HIE组血浆AM、ET-1水平生后1、3、7d均增高,与健康对照组比较,轻度组至3、7d已无显著性差异(Pa>0.05);中重度组至7d仍有显著性差异(Pa<0.05)。AM/ET-1值在3个时间点均较健康对照组减低,但仅中重度组生后1、3d与健康对照组比较有统计学意义(Pa<0.05)。2.HIE患儿血清NSE水平生后1、3d增高,与健康对照组比较,仅中重度组有显著性差异(Pa<0.05);7d,轻度组下降至健康对照组水平(P>0.05),中重度组与健康对照组比较有显著性差异(P<0.05)。且与AM/ET-1值呈显著负相关(r=-0.53P<0.05)。结论AM和ET-1共同参与HIE调节局部脑血流量及血脑脊液屏障功能的维护,AM/ET-1值测定对了解不同时期HIE患儿脑血流变化和脑损伤程度有重要意义。

Objective To explore the relationship of the ratio of plasma adrenomedullin（AM） and endothelin - 1 （ET - 1 ） with serum concentration of neuron - specific enolase（ NSE ） in full - term neonates with hypoxic - ischemic encephalopathy （ HIE ）. Methods Plasma concentrations of AM, ET- 1 and serum NSE from 32 full- term neonates with HIE were detected by radioimmunoassay （RIA） on the 1,3 and 7 d after parturition ,30 neonates in the corresponding periods in our hospital were employed as controls. The infants with HIE were divided into mild, moderate or severe group in terms of diagnostic standard of HIE. Results 1. Plasma concentrations of AM and ET - 1 in newborns with mild, moderate or severe HIE were significantly higher than that of control group at 1 d after life with a decline from 3 - 7 d （Pa 〈 0.05 ）, and that was significantly higher in the moderate or severe HIE group than that in control group at 7 d （ Pa 〈 0.05 ）. The ratio of plasma AM and ET - 1 in newborns with moderate or severe HIE were significantly lower than that in control group on 1,3 d（Pa 〈0.05）. 2. Serum concentration of NSE in neonates with moderate or severe was markedly higher than that of control group on 1,3 d（P. 〈0.05 ）. There was also a negative relationship between the ratio of plasma AM/ET- 1 and the serum concentration of NSE in neonates with HIE （r = -0.53 P 〈 0.05 ）. Conclusions AM can cooperate with ET - 1 in the regulation of regional cerebral blood flow and in maintenance of specific blood - brain barrier. Determination of the ratio of plasma AM/ET - 1 may demonstrate the flow of regional cerebral blood for evaluating the degree of brain injury.