神经节苷脂对早产脑白质损伤患儿神经行为发育的影响

Effect of monosialoteterahexosyl ganglioside on neurobehavioral development in premature infants with white matter damage

目的 探讨神经节苷脂对早产儿脑白质损伤神经行为发育的影响。方法2005年1月至2009年5月我院NICU收治的早产儿共636例，出生后1周内常规行床边头颅B超检查，确诊为早产儿脑白质损伤的患儿40例，随机分为治疗组与对照组，各20例。治疗组在出生后1周内给予单唾液酸四己糖神经节苷脂钠（GM1）20mg／d加入葡萄糖液中静脉滴注，1疗程为14d，根据病情使用1～3个疗程，其他治疗措施同对照组。2组脑白质损伤早产儿均于纠正胎龄40周时进行新生儿行为神经测定，在纠正年龄3、12个月时采用婴幼儿智能发育量表，评估神经系统发育情况。结果治疗组在纠正胎龄40周时的行为神经测定得分为（38．10±0．91）分，明显高于对照组（36．10±1．59）分（t=4．88，P〈0．05）。3个月和12个月时进行的智能发育评估显示智力发育指数（MDI）和心理运动发育指数（PDI），治疗组（3个月MDI：91．66±6．38，PDI：87．11±5．57；12个月MDI：104．10±6．45，PDI：100．46±3．87）均明显高于对照组（3个月MDI：81．074-0．72，PDI：81．90±6．70；12个月MDI：98．45±8．57，PDI：95．91±6．59）（P均〈0．05）。结论GM1对早产儿脑白质损伤神经行为发育有促进作用。

Objective To study the effect of monosialoteterahexosyl ganglioside （GM1） on neurobehavioral development in premature infants with white matter damage. Methods A total of 636 premature infants who were hospitalized in NICU of two hospitals from Jan 2005 to May 2009 received routine bedside cranial sonography detection before 1 week-aged. Forty premature infants were diagnosed as being premature white matter damage and divided into the treatment group （20 cases） and the control group （20 cases） randomly. The cases in the treatment group accepted GM1 20 mg additional to 5% glucose solutionthe iv drip, one time per day, for a cycle of 14 d. 1 -3 cycles were given in accordance with patient＇s condition. Other treatments were same to the control group. All cases were evaluated by neonatal behavioral and neurological assessment （NBNA） at the rectified age of 40 gestational weeks and by Children＇s Developmental Center of China （CDCC） test at 3 months-aged and 12 months-aged. Results The NBNA scores of the treatment group （38. 10 ± 0. 91 ） were significantly higher than the control group （ 36. 10 ±1.59 ） at the rectified age of 40 gestational weeks （ P 〈 0. 01 ） . The indexes of mental development （ MDI ） and psychomotor perfoimance development （PDI） by the CDCC tests in the treating group （3 months-aged MDI：91.66 ±6. 38;PDI：87.11 ± 5.57 ; 12 months-aged MDI ： 104. 10 ± 6.45 ; PDI ： 100.46 ± 3.87 ） were significantly higher than those in the control group （3 months-aged MDI：81.07 ±0. 72;PDI：81.90 ±6.70;12 months-aged MDI：98.45 ±8. 57;PDI： 95.91 ± 6. 59） at 3 months-aged and 12 months-aged （ P 〈 0. 05 ）. Conclusion GM1 can accelerate the neurobehavioral development in premature infants with white matter damage.