尼莫地平对缺氧缺血性脑病患儿红细胞胞质游离钙的影响及其临床意义

Influence of Nimodipine on [Ca^(2+)]i Levels in Red Blood Cell in Newborn Infants with Hypoxic-Ischemic Encephalopathy and Its Clinical Significance

目的探讨HIE患儿体内红细胞胞质游离钙(RBC[Ca2+]i)水平的变化及尼莫地平治疗对其的影响。方法将58例中重度HIE随机分成HIE常规治疗组(28例)和尼莫地平组(30例),选取20例健康新生儿为健康对照组。尼莫地平组入院后在常规治疗的基础上给予尼莫地平治疗[2mg,0.5～1.0μg/(kg.min),连用7～10d]。HIE患儿于治疗前、治疗72h和治疗10～14d各采集静脉血2mL,并采集健康新生儿静脉血2mL,采用荧光钙指示剂(Fura-2/AM)法检测其RBC[Ca2+]i水平。应用SPSS10.0软件进行统计学分析。结果1.HIE患儿RBC[Ca2+]i水平显著高于健康对照组[(2.85±0.36)mmol/Lvs(2.15±0.18)mmol/L,P<0.01]。RBC[Ca2+]i水平与HIE程度存在明显正相关(r=0.447P<0.05)。2.HIE常规治疗组和尼莫地平组新生儿RBC[Ca2+]i水平于出生72h达较高水平,然后逐渐恢复,治疗10～14d尼莫地平组新生儿RBC[Ca2+]i水平与HIE常规治疗组比较有显著性差异[(2.32±0.10)mmol/Lvs(2.68±0.14)mmol/L,P<0.05]。结论RBC[Ca2+]i参与HIE的病理生理过程,在HIE发病机制中可能起重要作用,动态监测RBC[Ca2+]i水平可能有助于HIE的早期诊断和预后判断;尼莫地平能显著降低RBC[Ca2+]i水平,减轻脑损伤。

Objective To explore change of RBC [ Ca^2＋ ] i levels in neonates with hypoxic - ischemic encephalopathy （HIE） and the influence of nimodipine on RBC [ Ca^2＋ ] 1 and its clinical significance. Methods Fifty - eight neonates with moderate and severe HIE were randomly divided into 2 groups including routine treatment group （n = 28 ） and nimodipine group （n = 30 ） , and 20 healthy full - term neonates were selected as healthy control group. Based on the routine treatment,nimodipine[2 mg,0.5 - 1.0 μg/（ kg · min） ] was given intravenously in the nimodipine group for 7 - 10 days. Blood samples were collected before and after treatment for 72 hours and 10 - 14 days, respectively. The levels of RBC[ Ca^2＋ ] i were measured by Fura - 2 pentakis（acetoxymethyl） ester[ Fura - 2/AM]. The results were analyzed by SPSS 10.0 software. Results 1. The levels of RBC [ Ca^2＋ ] i in neonates with HIE were significantly higher than those in healthy control group [ （2. 83 ＋ 0. 36） mmol/L vs （2.15 ± 0.18 ） mmol/L,P 〈 0.01 ]. Correlation analysis showed that RBC [ Ca^2＋ ] i levels in neonates with HIE were correlated positively with the severity of HIE （ r = 0. 447 Pa 〈 0.05 ）. 2. After treatment for 72 hours, the levels of RBC [ Ca^2＋ ] j in neonates were obviously elevated in routine treatment group and nimodipine group. The levels of RBC [ Ca^2＋] i showed prolonged elevation at 72 hours after birth. After treatment for 10 - 14 days,the RBC[ Ca^2＋ ] i levels in neonates were significantly lower in nimodipine group than that in routine treatment group [ （2.32 ±0.10） mmol/L vs （2.68 ±0.14） mmol/L,P 〈0.05]. Conclusions RBC[ Ca^2＋ ]i levels are closely associated with pathophysiological process of HIE, and may play an important role in the pathogenesis of HIE. Evaluating RBC [ Ca^2＋]i levels in neonates after birth may be helpful to monitor the early diagnosis, severity and prognosis of HIE. Nimodipine can significantly reduce the levels of RBC[ Ca^2＋]i and alleviate brain injury.