早产儿重度脑室内出血脑脊液糖浓度的变化及机制探讨

A Study on Mechanism and Change of Glucose Concentration of CSF in Premature Rabbits with Severe IVH

目的探讨早产儿重度脑室内出血脑脊液糖浓度的变化及可能机制。方法对解放军白求恩国际和平医院17例早产儿重度脑室内出血（IVH）脑脊液糖浓度进行客观描述;通过早产兔重度IVH模型,应用蛋白印迹方法,定量分析脑室周围脑组织葡萄糖转运体GLUT1和GLUT3蛋白表达。结果 17例重度IVH早产儿脑脊液平均糖浓度降低,尤以出血后16~20 d降低更明显,随后逐步恢复,26~30 d仍低于文献给出的正常范围;重度IVH早产兔脑组织标本中GLUT1蛋白表达量生后24 h最高,其次是生后48 h,最后是生后72 h,3个时间点间两两比较差异有统计学意义（P〈0.05）;重度IVH早产兔脑组织标本中GLUT1蛋白表达量在生后72 h低于同一时间点的对照组（P〈0.01）,而24、48 h均高于同一时间点的对照组（P〈0.01）;重度IVH早产兔脑组织中GLUT3蛋白表达量在生后24、48、72 h 3个时间点两两比较,差异有统计学意义（P〈0.05）,以生后48 h蛋白表达量最高,其次是生后24 h,最后是生后72 h,而GLUT3蛋白表达量在生后24 h与对照组同一时间点相比较,差异无统计学意义（P〉0.05）,生后48 h的蛋白表达量高于同一时间点的对照组（P〈0.01）,生后72 h时蛋白表达量低于同一时间点对照组（P〈0.01）。结论重度IVH早产兔脑部GLUT1蛋白表达量有暂时性升高,随后表达降低,推测由此导致脑脊液糖浓度降低;脑内GLUT3蛋白的相对表达量有暂时性升高,之后下调,可能导致葡萄糖供应不足,提示有可能参与了早产儿基质-脑室内出血后继发性脑损伤。

Objective To study possible mechanism of reducing glucose-concentration in cerebrospinal fluid （CSF） in premature infants with severe intraventrieular hemorrhage （IVH）. Methods Levels of CSF glucose-concen- tration in 17 premature infants with severe IVH were objectively described. Expressions of glucose transporter GLUT1 and GLUT3 proteins in brain tissue in IVH preterm rabbits were quantitatively analyzed using Western Blot. Results Average CSF glucose-concentration in the 17 premature infants decreased, the obviously decreased value was found in 16-20 d after the bleeding, and then the value was gradually restored, but the value was still lower on 26-30 d after the bleeding than the normal range in the literature. In severe IVH model group, expressions of GLUT1 protein from high to low were at 24 h, 48 h and 72 h after birth in turn, and the differences were statistically significant between each two time point （P 〈 0.05）. In severe IVH model group, at 72 h after birth, expression of GLUTI protein was lower than that in control group （P 〈0.01） at 24 and 48 h after birth, the expressions were higher than those in control group （P 〈0. 01 ）; expression differences of GLUT3 protein were statistically significant between each two time point （ P 〈 0.05 ） , and the highest expression was found at 48 h, and followed by 24 h and 72 h after birth. In severe IVH model group, at 24 h after birth, there was no significant difference in GLUT3 protein expression compared with that in control group （ P 〉 0. 05 ） ; at 48 h after birth, the expression was higher than that in control group （P 〈 0. 01 ） ; at 72 h after birth, the expression was lower than that in control group （P 〈 0.01 ）. Conclusion Expression of GLUT1 protein in brain of severe IVH preterm rabbits has a temporary increase, and then it begins to decrease, which may possibly induce reducing of glucose concentration in cerebrospinal fluid. Expression of GLUT3 protein in brain has a temporary increase, and then it begins to decrease, which may lead to inadequate supply of glucose, and therefore it suggests that it may be involved in secondary brain injury after severe germinal matrixintraventricular hemorrhage （GM-IVH）.