缺氧缺血性脑病患儿血浆内皮素1与降钙素基因相关肽变化及其对脑血流动力学的影响

The Change of Endothelin-1 and Calcitonin Gene-related Peptide in Neonatal Hypoxic-ischemic Encephalopathy and Its Influence on Cerebral Hemodynamics

目的 研究新生儿缺氧缺血性脑病 (HIE)时血浆内皮素 1(ET- 1)、降钙素基因相关肽(c GRP)的变化及其对脑血流动力学的影响。 方法 用放射免疫法检测了 4 0例 HIE患儿和 4 0例正常新生儿脐血及生后 1、3、7d外周血 ET- 1与 c GRP的动态变化 ,并于生后 2 4 h取内外周静脉血后即刻应用脉冲多谱勒超声检测 HIE患儿大脑中动脉的血流动力学参数。 结果 (1) HIE患儿脐血与生后第 1天血浆 ET- 1水平分别为 (70± 2 5 ) ng/ L、(5 7± 14 ) ng/ L ,对照组分别为 (38± 19)ng/ L、和 (35± 99) ng/ L (P值均 <0 .0 0 1) ;c GRP水平分别为 (2 86± 14 3) ng/ L、(2 91± 15 4 ) ng/ L ,对照组分别为 (186± 87) ng/ L、(196± 10 4 ) ng/ L (P值均 <0 .0 0 1) ;至生后 1周末时 ET- 1可恢复正常 ,而 c GRP仍显著高于对照组。 (2 )多谱勒超声显示 HIE患儿脑血流阻力增加、血流速度减慢。 (3)直线相关回归分析表明 ,HIE脑血流阻力指数 (RI)与 ET- 1呈正相关 (r=0 .72 4 ,P<0 .0 1) ,与 c GRP呈负相关 (r=- 0 .719,P<0 .0 1)。 结论 新生儿窒息后 ET- 1、c GRP参与了 HIE的病理生理过程 ,其平衡失调可能是 HIE脑血流动力学紊乱的原因之一。窒息新生儿早期使用 c GRP或 c GRP活性样药物 ,对防止或减轻缺氧缺血性?

Objective To study the variation of endothelin 1(ET 1) and calcitonin generelated peptide(cGRP) and its clinical implication, and to analyze the influence of ET 1 and cGRP on cerebral arteries hemodynamics in neonates with hypoxic ischemic encephalopathy(HIE). Methods The variation of ET 1,cGRP in cord blood and peripheral blood were prospectively observed at the time of 1 day,3 days and 7 days after birth in HIE and healthy control infants by radioimmuneassay. The cerebral arteries hemodynamics were determined immediately using color Doppler ultrasonography at 1 day after blood samples were obtained. Results (1) The following factors in cord blood and vein one day after birth in neonatal HIE and healthy controls was: ET 1(70±25)ng/L vs (38±19) ng/L ( P <0.001) and (57±14) ng/L vs (35±9) ng/L( P <0.001),cGRP(286±143) ng/L vs(186±87) ng/L( P <0.001) and (322±154) ng/L vs (196±104) ng/L( P <0.001). (2) The Dopple ultrasonography showed the cerebral arteries blood velocity was decreased while cerebral blood resistance was increased.(3) Linear regression showed that ET 1 and cGRP have significant influence on cerebral arteries hemodynamics in neonates with HIE. Conclusion The imbalance of ET 1 and cGRP in asphyxiated neonates may be one of the main reasons of cerebral hemodynamic disturbance in neonatal HIE.