新生儿缺氧缺血性脑病血清神经肽Y和降钙素基因相关肽动态变化的临床意义

The Clinical Significance of Dynamic Observation on Serum Neuropeptide Y and Calcitonin Gene Related Peptide in Neonates with Hypoxic-ischemic Encephalopathy

目的：探讨血清神经肽Y（NPY）和降钙素基因相关肽（CGRP）在新生儿缺氧缺血性脑病（HIE）中的变化及其意义。方法：2008年1月~2009年12月本院新生儿科收治的32例HIE患儿,10例正常足月新生儿,在生后24 h、第3 d、第7 d取血,进行血清NPY和CGRP检测。结果：生后24 h内HIE组血清NPY质量浓度显著高于对照组（P〈0.01）,且随着病情加重,NPY质量浓度越高;中、重度HIE组NPY质量浓度明显高于轻度HIE组（P〈0.01）。NPY浓度以生后24 h内最高,第3 d开始下降,第7 d左右下降最为明显,但仍高于正常对照组。在24 h、3 d、7 d三个时间点,经方差分析显示三组HIE相互之间比较差异有统计学意义（P〈0.01）。HIE患儿CGRP随着病情加重而相应升高。轻、中、重度HIE患儿血清CGRP与对照组比较差异有统计学意义（P〈0.01）,其水平以生后24 h升高最为明显。结论：血清NPY与CGRP可作为判断HIE脑损伤程度、病情发展、判断预后的较为客观的指标,特别是动态测定血清NPY对HIE具有更重要的早期诊断和判断预后的临床价值,可推广应用于临床。

Objective：To study the significance and changes of serum neuropeptide Y（NPY） and calcitonin gene related peptide（CGRP） in neonates with hypoxic-ischemic encephalopathy（HIE）.Methods： There were 32 cases of HIE neonates and 10 cases of normal full-term newborn infants in our hospital from January 2008 to December 2009.They were phlebotomized at 24 hours,3 days,7 days after birth and the serum NPY and CGRP were measured.Results： The levels of serum NPY in HIE group were significantly higher than the control group within 24 hours（P0.01）.Furthermore,the levels of NPY were higher when the patients＇ condition worsened.The levels of serum NPY in medium and severe HIE group were significantly higher than the mild HIE group（P0.01）.The levels of serum NPY peaked in 24 hours,decreased in 3 days and reached its bottom in 7 days.While still higher than the control group,it had significant differences between three HIE groups in 24 hours,3 days and 7 days through variance analysis and F-test（P0.01）.The levels of CGRP in HIE group rose when the patients＇ condition worsened.The levels of CGRP had significant differences between three HIE groups and control group（F-test）（P0.01） and reached the peak in 24 hours.Conclusions： Serum NPY and CGRP are objective indicators to estimate the extent of brain damage,the progress of the illness and the judgment of the prognosis.Dynamic determination of serum NPY has especially important clinical value in early diagnosis and prognosis judgment of HIE.It could be widely used in clinic.