窒息新生儿血肉碱谱与脑损伤相关性的研究

Study on the relativity between carnitine and acylcarnitines of neonatal asphyxia and brain damage

目的:采用串联质谱法技术,进行窒息新生儿血肉碱谱与脑损伤相关性的研究,并观察不同程度的窒息新生儿血肉碱谱的变化规律。方法:研究对象为胎龄≥37周,体重≥2.5 kg的窒息新生儿组,对照组为正常的足月产新生儿。每组各选取50例入组。检测研究组所有娩出后新生儿的脐血,生后1周,生后1个月的外周血,检测血肉碱谱。并于上述相同的时间内收集记录患儿的临床信息及实验室、影像学检查结果等,分为窒息后发生脑损伤组与非脑损伤组。结果:①窒息新生儿组的血游离肉碱及总肉碱水平均低于正常新生儿对照组(P<0.05)。②窒息后发生脑损伤的新生儿在生后1周内血游离肉碱及总肉碱水平均明显低于非脑损伤组(P<0.01),而长链酰基肉碱在生后1周内较非脑损伤组明显升高(P<0.05)。③重度窒息的新生儿在生后1周内游离肉碱、短链、中链酰基肉碱水平较轻度窒息组低,长链酰基肉碱水平则高于轻度窒息组,差异有统计学意义(P<0.05),生后1个月两者比较差异无统计学意义(P>0.05)。结论:窒息新生儿的血肉碱谱变化与脑损伤的发生存在关联,血肉碱谱的变化可以协助早期判断及评估新生儿窒息后脑损伤的发生及预后。

Objective： To study the relativity between carnitine and acylcarnitines of neonatal asphyxia and brain damage by adopting the technology of tandem mass spectrometry, and to observe the change pattern of camitine and acylcarnitines of neonatal asphyxia in var- ying degrees. Methods： Fifty asphyctic neonates bore in our center with a birth term over 37 weeks and a body weight over 2. 5 kg were taken as neonatal asphyxia group, and 50 term infants were taken as control group. The naval blood and peripheral blood after one week and one month of their birth were detected, so as to study the carnitine and acylcarnitines. These objects were further divided into neonatal asphyxia group and neonatal non - asphyxia group according to the records of their clinical data and examination results in laboratory and imigeology. Results： （1）The levels of carnitine and acytcarnitines and total carnitine and acylcarnitines （TC - AC） of the neonatal asphyxia group were generally lower than that of the control group （ P 〈 0. 05 ） . （2）The level of carnitine and TCAC of the neonatal followed with brain damage after asphyxia was evidently lower than that of those neonatal without brain damage （P 〈 0. 01 ）, while the level of long chain acylc- arnitines （ LC - AC） in one week after birth went sharply higher than that of the neonatal without brain damage （ P 〈 0. 05 ） . （3）The levels of carnitine, short chain acylcarnitines （SC -AC） and medium chain acylcarnitines of the neonatal with severe asphyxia in one weekg birth were lower than that of those neonatal with minimal asphyxia, while the level of LC - AC was higher than that of the latter. The difference （P 〈 0. 05） was significant in statistics but the comparison of the neonatal data after one monthg birth between these two groups was none of any statistics significance （ P 〉 0. 05 ） . Conclusion： The change of carnitine and acylcarnitines of neonatal asphyxia is in relation with the occurrence of brain damage. The change of camitine and acylcarnitines facilitate judging and evaluating the occurrence of brain damage and prognosis for neonatal asphyxia in an early stage.