缺氧缺血性脑病患儿红细胞胞浆游离钙水平变化的临床意义

Clinical significance of changes of RBC[Ca^2＋]i levels in the neonates with hypoxic-ischemie encephalopathy

目的探讨红细胞胞浆游离钙（RBC[Ca^2＋]i）在缺氧缺血性脑病（HIE）发病机制中的作用及其应用价值。方法选择2002年6月至2006年3月我科收治的28例中、重度HIE患儿作为研究对象，HIE患儿人院后在常规治疗的基础上给予尼莫地平治疗，疗程7～10d。于治疗前、治疗72h和7—10d各采集静脉血1次，采用Fura-2／AM法检测RBC[Ca^2＋]i水平。以我院产科同期收住的20例正常新生儿作为对照组。结果（1）中、重度HIE组治疗前后各时间点RBC[Ca^2＋]i水平均明显高于对照组，差异具有显著性（P〈0．05，P〈0．01），中、重度HIE组间差异无显著性（P〉0．05）。（2）HIE患儿RBC[Ca^2＋]i水平于治疗后72h达到高峰，然后逐渐恢复，至治疗7～10d仍高于对照组（P〈0．05）。（3）RBC[Ca^2＋]i水平与HIE程度存在明显正相关（r=0．447，P〈0．05）。结论RBC[Ca^2＋]i参与了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[Ca^2＋]i水平可能有助于HIE的早期诊断和预后判断。

ObJective To explore the role of RBC[Ca^2＋]i levels in pathogenesis of hypoxic-ischemic encephalopathy （HIE） in neonates. Methods Twenty-eight neonates with moderate and severe HIE hospitalized from Jun. 2002 to Mar. 2006 were enrolled the study. The neonates with HIE were given routine treatment and Nirnodipine for 7 - 10 days. Blood samples were collected before treatment and at 72 hours ,7 - 10 days after treatment respectively. The levels of RBC [Ca^2＋] i were measured by Fura-2/AM. Twenty healthy full-term neonates were studied as controls. Results （ 1 ） The levels of RBC[ Ca^2＋ ] i in the neonates with moderate and severe HIE were significantly higher than that in control group at every time points （ P 〈 0. 05,P〈0. 01）. （2） the levels of RBC[Ca^2＋]i in the neonates with moderate and severe HIE peaked at 72 hours after treatment,and were still significantly higher than that of control group at 7 - 10 days after treatment （ P 〈 0. 05 ）. （3） In the neonates with HIE, RBC [ Ca^2＋ ] i levels correlated positively with the severity of HIE （ r = 0. 447,P 〈 0. 05 ）. Conclusion RBC [ Ca^2＋ ] i levels are closely associated with pathogenesis of H/E, and may play an important role in the pathogenesis of HIE. Evaluating RBC [ Ca^2＋ ] i levels in neonate after birth may provide clinical clues for the early diagnosis and prognosis assessment of HIE.