连续腰穿对重度脑室内出血早产儿脑脊液中非蛋白结合Fe^2＋和丙二醛水平的影响

The changes of cerebrospinal fluid non-protein-bound iron and malondialdehyde（MDA） in preterm infants with severe intraventricular hemorrhage （IVH） after serial lumbar punctures

目的探讨连续腰穿对重度脑室内出血（IVH）早产儿脑脊液中非蛋白结合Fe^2＋和丙二醛（MDA）水平的影响。方法对20例重度IVH早产儿行连续腰穿治疗，检测首次和末次腰穿脑脊液标本中的非蛋白结合Fe^2＋和MDA水平，20例对照组早产儿在生后7～14d内只取一次脑脊液标本。结果重度IVH组首次腰穿脑脊液中非蛋白结合Fe^2＋水平[（0．66±0．38）μmol／L]较对照组[（0．24±0．12）μmol／L]高，MDA水平[（1．21±0．41）μmol／L]亦较对照组[（0．89±0．35）μmol／L]高，差异均有显著性（P〈0．01，P〈0．05）；重度IvH伴出血后脑室扩张（PHVD）者在首次和末次腰穿脑脊液中非蛋白结合Fe^2＋水平[（0．75±0．34）μmol／L、（0．57±0．21）μmol／L]均较未发生PHVD者[（0．54±0．31）μmol/L、（0.35±0.18）μmol/L升高，差异有显著性（P〈0.05），而水平两者差异无显著性；两者在末次腰穿时脑脊液非蛋白结合Fe^2＋水平均较首次腰穿时降低，差异有显著性（P〈0．05），而MDA水平无明显变化。结论重度IVH早产儿脑脊液中非蛋白结合Fe^2＋和MDA水平升高，可能与Fe^2＋和氧自由基参与早产儿脑白质损伤有关，连续腰穿治疗可以降低脑脊液中非蛋白结合Fe^2＋水平。

Objective To investigate the changes and clinical significance of cerebrospinal fluid （CSF） non- protein-bound iron and malondbldehyde（MDA） in preterm infants with severe intraventricular hemorrhage （IVH） after serial lumbar punctures. Methods Non-protein-bound iron and MDA of CSF in twenty severe IVH preterm infants with first and end lumbar puncture were examined respectively. The control samples were determined for once from first to second week after birth. Results Both Non-protein-bound iron and MDA levels of the first CSF sample in twenty severe IVH preterm infants were higher than that in control [ （0.66 ± 0.38） μmol/L vs （0.24 ± 0.12） μmol/L（P〈0.01） ;（1.21 ± 0.41） μmol/L vs （0.89 ± 0.35） μmol/L（P〈 0.05） ]. Non-protein-bound iron levels of first and end CSF sample in severe IVH with posthemorrhagic ven- tricular dilatation （PHVD） were both higher than those without PHVD [ （0.75 ± 0.34） μmol/L vs （0.54 ± 0.31 ）μmol/L; （0.57 ± 0.21 ）μmol/L vs （0.35 ± 0.18）μmol/L] （ P 〈 0.05）. However, there was no significant difference in MDA levels between both groups. The levels of non-protein-bound iron of end CSF in severe IVH with and without PHVD were significantly lower than those of the first CSF samples （P 〈 0.05）, while, there was no significant difference in MDA levels between the end and first CSF samples. Conclusion The non-protein-bound iron and MDA of CSF in severe IVH preterm infants were both significantly increased, non- protein-bound iron and oxygen free radicals may be involved in the preterm brain injury. Serial lumbar punctures can lower the levels of non-protein-bound iron in CSF.