血清IL-10水平与脑损伤及预后的关系以及NDT对其的影响

Relationship between serum IL- 10 level and prognosis of brain injury in children with cerebral palsy and effect of NDT on prognosis

目的：动态观察胎儿脐血、新生儿、脑瘫（cerebralpalsy，CP）患儿血清Th2型细胞因子白细胞介素-10（IL-10）水平与脑损伤及预后的关系；观察神经发育疗法（NDT）对脑瘫患儿IL-10水平的影响和粗大运动功能量表（GMFM）-88项量化评价NDT治疗前后脑瘫患儿粗大运动功能发育变化的影响；探讨具有抗炎和免疫调节作用的Th2型细胞因子IL-10和GMFM-88项对NDT治疗脑瘫疗效评价的意义。方法：采取自身前后对照、病例-对照的方法，应用双抗体夹心酶联免疫吸附试验法分别检测脑瘫组NDT治疗前后和脑瘫高危因素胎儿脐血病例组、新生儿病例组的血清IL-10水平，GMFM-88项对NDT治疗前后脑瘫惠儿粗大运动功能进行量化评估。结果：NDT治疗前脑瘫组血清IL-10水平明显低于其对照组（P〈0．01）；NDT治疗后脑瘫组血清IL-10水平明显高于其对照组、NDT治疗前脑瘫组（P〈0．01）；CP高危因素胎儿组血清IL-10水平显著低于其对照组，CP高危新生儿组及NDT治疗后脑瘫组（P〈0．01）；CP高危因素新生儿组血清IL-10水平明显高于其正常对照组、NDT治疗前脑瘫组（P〈0．01）；脑瘫NDT治疗后血清IL-10水平与CP高危因素新生儿组比较有统计学差异（P〈0．01），后者较高；脐血对照组血清IL-10水平较新生儿对照组及脑瘫对照组高（P〈0．05）；NDT治疗后脑瘫组GMFM-88项分值明显高于NDT治疗前（P〈0．01）。结论：胎儿在宫内既存在细胞毒免疫反应亢进，又存在局部体液免疫反应明显减弱，与急、慢性宫内感染所致的缺氧缺血性脑损伤，宫内缺氧缺血、围产期感染有关；IL-10在发挥抗炎效应的同时，其内源性消耗量超过合成量所致，这是脑瘫发生、发展的关键环节；NDT可促进内源性IL-10的合成和分泌，这也是粗大运动功能恢复的重要机制之一；GMFM能够客观评价脑瘫NDT治疗前后粗大运动功能发育的变化，综合评估IL-10和GMFM，可以较为全面客观地评价NDTV治疗方法的疗效，进而为早期干预及个体化康复计划提供治疗依据以及相应的治疗方案。

Objective： To explore the relationship between interleukin- 10 （IL- 10） and brain injury or its prognosis of fetuses, neonates and children with cerebral palsy （CP） ; and to observe the effect of neurodevelopmental treatment （NDT） on IL- 10 levels and on motor function of CP patients. Methods： Serum samples were obtained from 50 CP children, 20 fetuses with CP risk factors, 25 neonates with CP risk factors and control groups respectively and kept at --20℃ until the time of measurement. IL- 10 levels were measured by the enzyme--linked immunosorbent assay double sandwich method （ABC-- ELISA） retrospectively. The curative effect of NDT were quantitatively assessed by GMFM--88 items before and after treat- ment. Results： The levels of serum IL- 10 in fetuses with CP risk factors were significantly lower than those in control group （P d0.01） ; Serum IL- 10 Levels of neonates with CP risk factors were significantly higher than those of controls （P〈0.01） ; Serum IL- 10 levels of CP children without NDT were significantly lower than those of controls （P〈0.01） ; Serum IL- 10 levels of CP children with NDT were significantly higher than in the CP patients without NDT and in controls （P〈0.01）. Serum IL- l0 levels of CP children with NDT were significantly lower than in neonates with CP risk factors （P〈0.01）. The total scores of GMFM- 88 in CP children with NDT were significantly higher than in the CP patients without NDT （P〈0.01）. Conclusions： The fetuses have both cytotoxic immune hyperfunction and partial decrease of humoral immunity, and it is closely related with hypoxic--ischemic encephalopathy caused by acute and chronic intrauterine infection. The neonates have hyperfunction of cytotoxic immunity and humoral immunity, and it is connected with uterine hypoxia, schemia and the infection during rinatal period. Endogenous consumption exceeds resultant quantity when anti- inflammatory effect of IL- 10 works, and this is a key to the occurring and the development of CP. NDT could promote the synthesis and secretion of the endogenous IL- 10, and it is also the mechanism of the recovery of gross motor function. GMFM- 88 can reflect the change of gross motor development in CP children and can be sensitively objectively quantified assessment of curative effect of NDT for CP. With IL- 10 and GMGM- 88, the curative effect of CP is overall assessed. Moreover, it provides the scientific basis for treatment plans of the neurological rehabilitation of CP children.