新生儿缺氧缺血性脑病血清NSE的变化及与纳络酮治疗的相关性

The changes and clinical significance of NSE in neonates with hypoxic ischemic encephalopathy and its correlation with naloxone treatment

目的动态观察神经元特异性烯醇化酶(NSE)在新生儿缺氧缺血性脑病(HIE)时及纳络酮治疗前后水平的变化,以探讨在临床中的意义。方法测定98例HIE患儿于生后24h、4天、7天及纳络酮治疗前后血清中NSE浓度,并进行比较。结果①重度HIE组血清NSE水平高于中度组,中度组高于轻度组,差异具有显著性(P<0.05),轻度组与对照组比较,差异无显著性(P>0.05)。②除对照组外,HIE各组血清NSE含量在第4天时明显升高,而在第7天时显著下降(P<0.05);与对照组相比,轻度HIE组NSE第7天接近正常(P>0.05),中度和重度组未达到正常值(P<0.05)。③纳络酮治疗组较常规治疗组NSE含量显著降低(P<0.05)。结论①HIE时血清中NSE含量明显增高,且其升高程度与病情危重程度密切相关。②纳络酮治疗HIE患儿可稳定神经元细胞膜,减少细胞凋亡,从而减少NSE的释放。③应在HIE发生后的4日以内尽早使用纳络酮,以更好地发挥神经保护作用。

Objective To observe the changes of blood neuron specific enolase（NSE） in neonates with hypoxic ischemic encephalopathy（HIE）,meanwhile,to explore therapeutic effects and possible mechanism of naloxone,and provide theoretical and practical basis for the treatment of HIE. Methods The levels of NSE were examined in treatment and control groups on the 1st、4th day and 7th day after birth. Results NSE in the severe HIE group were obviously higher than those in the mild and moderate HIE group （P ＆lt; 0. 05）. No difference was found between the mild and control groups （P 〉 0.05）. The levels of NSE in HIE groups on the 4th day after birth were higher than those on the 1st day（P 〈0.05 ）, and lower on the 7th day after birth, but still higher than those in the control group （P 〈 0.05）. The NSE levels of the treatment group with naloxone were reduced than that of the treatment group without naloxone significantly （P 〈 0.05）. Conclusion NSE may be involved in the occurrence and development of HIE, and its level is closely correlated with the severity of HIE. Naloxone could stabilize nerve cell membrane, reduce NSE release and should be used within 4 days in HIE cases to exert good protection effect on neuron function.