布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭对前列腺素E2的影响

Effect of ibuprofen and acetaminophen on prostaglandin E2 levels in preterm infants with symptomatic patent ductus arteriosus

目的研究口服布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭（sPDA）时，血浆和尿中前列腺素E2（PGE2）水平的变化。方法2012年10月-2015年6月本院新生儿病房收治符合纳入标准的早产儿sPDA87例，随机分组：布洛芬组（n=43）口服布洛芬10mg·kg-1．24h及48h后再各给予5mg·kg-1；对乙酰氨基酚组（n=44）口服对乙酰氨基酚15mg·kg-1，每6h1次，共3d。治疗72h后复查超声心动图，检测治疗前后血浆和尿PGE，水平。结果2组患者治疗后血浆和尿PGB浓度均明显低于治疗前（P〈0．05）；对乙酰氨基酚组治疗后血浆和尿PGE，下降幅度明显低于布洛芬组（P=0．031、0．002）。对乙酰氨基酚纽PDA闭合率与布洛芬组比较差异无统计学意义（P=0．506）；对乙酰氨基酚组少尿发生率低于布洛芬组，但差异无统计学意义（P=0．108）。2组治疗后大便隐血阳性率、脑室内出血、新生儿坏死性小城结肠炎、支气管肺发育不良发生率比较差异均无统计学意义（P〉0．05）。2组治疗后血小板、血肌酐、谷丙转氨酶均无明显变化（P〉0．05）。成功组与失败组治疗后血浆和尿PGE2浓度下降幅度差异均无统计学意义（P〉0．05），少尿组治疗后血浆和尿PGE2浓度下降幅度均明显高于非少尿组，差异具有统计学意义（P〈0．001）。血浆和尿PGE，浓度呈高度正相关（r=0．648，P=0．000）。结论口服对乙酰氨基酚治疗早产儿sPDA的疗效与布洛芬相似，不良反应均较少；对乙酰氨基酚使PGE2水平下降幅度弱于布洛芬，尿PGE2浓度测定较血浆PGE2浓度测定更适合临床应用。

Objective To study the changes of prostaglandin E2（PGE2） levels in the plasma and urine in preterm infants with symptomatic patent ductus arteriosus（s PDA） treated with oral ibuprofen and acetaminophen. Methods Totally 87 preterm infants with s PDA admitted to our hospital from Oct 2012 to Jun 2015 were randomly divided into 2 groups： an ibuprofen group（oral ibuprofen suspension was given an initial dose at 10 mg·kg- 1, followed by 5 mg·kg- 1 dose 24 and 48 h later, n = 43）, and an acetaminophen group（oral acetaminophen suspension was given at doses 15 mg·kg- 1 every 6 h for 3 days, n = 44）. Results PGE2 levels in the plasma and urine after the treatment were significantly lower than those before the treatment（P〈0.05）. After the treatment, PGE2 in the plasma and urine in the acetaminophen group declined obviously compared with those in the ibuprofen group（P = 0.031, 0.002）. The PDA closure rate of the acetaminophen group was similar to that of the ibuprofen group（P = 0.506）. Lower incidence of oliguria was found in the acetaminophen group than in the ibuprofen group, without significant difference（P = 0.108）. The fecal occult blood positive rate, intraventricular hemorrhage, neonatal necrotizing enterocolitis, and bronchopulmonary dysplasia occurred at a similar rate after the treatment in the 2 groups（P〉0.05）. There was no significant change in the platelet, serum creatinine and alanine transaminase after the treatment in the 2 groups（P〉0.05）. PDA closure, the 2 groups after the treatment has not closed group（success） and PDA（failure） of PGE2 levels in the plasma and urinary drop similar（P〉0.05）, while the 2 groups after the treatment oliguria plasma and urinary PGE2 levels decreased significantly greater than in the oliguria group（P〈0.001）. PGE2 levels in the plasma and urine were highly correlated（r = 0.648, P = 0.000）. Conclusion The clinical efficacy of oral ibuprofen and acetaminophen for preterm infants with s PDA is similar with low adverse events. PGE2 levels decreases less by acetaminophen than by ibuprofen. Urinary PGE2 level is more suitable in clinical practice than plasma PGE2.