新生儿窒息后血浆褪黑素水平变化的临床研究

Clinical Study on changes of plasma melatonin levels in neonates after perinatal asphyxic episodes

目的研究新生儿窒息后血浆褪黑素(MT)水平的变化,阐明褪黑素在新生儿窒息及缺氧缺血性脑病(HIE)发生发展过程中的作用,并为临床应用提供依据。方法选择正常足月新生儿12名的脐动脉血标本为对照组。足月新生儿窒息病例36例为观察组,其中轻度窒息12例,重度窒息24例,重度窒息中并发HIE12例;分别于急性期(生后24h内)和恢复期(生后第7天)采股静脉血标本,用酶联免疫分析法检测血浆褪黑素水平。结果窒息急性期、恢复期与正常对照组相比,褪黑素水平升高有统计学意义(P<0·05和P<0·01);窒息恢复期与急性期相比,褪黑素水平升高有统计学意义(P<0·01)。无HIE组急性期与对照组相比,褪黑素水平变化无统计学意义(P>0·05);其余各组与对照组相比,褪黑素水平升高均有统计学意义(P<0·01)。无HIE组恢复期与急性期相比及急性期HIE组与无HIE组相比,褪黑素水平升高有统计学意义(P<0·01);HIE组恢复期与急性期相比及恢复期HIE组与无HIE组相比,褪黑素水平变化无统计学意义(P>0·05)。结论新生儿窒息后及并发HIE时血浆褪黑素水平均升高,提示对机体有一定的保护作用。

Objective To study the changes of plasma melatonin （MT） levels in neonates after perinatal asphyxic episodes and to study the role of MT in perinatal asphyxia and the development of hypoxic-ischemic encephalopathy （HIE） so as to provide evidence for the clinical usage of MT to treat HIE. Methods Twelve healthy full term infants worked as control group; Thirty-six full term infants with perinatal asphyxia were enrolled in experimental group, 12 mild cases and 24 severe cases, including 12 cases developed HIE. Plasma MT levels were measured via enzyme-labeled immunosorbent assay （ELISA） in acute stages （within 24 hours after birth） and recovery stages （7 days after birth） of perinatal asphyxia. Results The level of MT increased significantly in acute and recovery stages of neonates in experimental groups compared with that in control group （P 〈 0. 05 and P 〈 0. 01 respectively）. The levels increased significantly in recovery stage compared with that in acute stage of neonates with asphyxia （P 〈 0. 01 ）. The changes of levels of MT in acute stage of neonates without HIE showed no significant differences compared with that in control group （P 〉 0. 05 ）, the others in experimental groups showed significant differences compared with control group （P 〈 0. 01 ）. The MT levels increased significantly in recovery stages compared with that in acute stage of neonates without HIE and in acute stage of neonates with HIE compared with that of neonates without HIE （ P 〈 0. 01 ）. The changes of levels of MT in recovery stages showed no significant differences compared with that in acute stages of neonates with HIE and same was true for that in recovery stages of neonates with HIE compared with that in neonates without HIE （P 〉 0. 05）. Conclusion The level of MT increases after neonatal asphyxic episode and it increases when asphyxia is complicated with HIE. Results suggest that MT has protective effect in HIE.