脑苷肌肽注射液联合加热湿化高流量鼻导管对HIE患儿血清IGF-1、sTREM-1、MBP水平及预后的影响

EFFECT OF CATTLE ENCEPHALON GLYCOSIDE AND IGNOTIN INJECTION COMBINED WITH HIGH FLOW NASAL CATHETER VENTILATION WITH HEATED HUMIDIFICATION ON SERUM LEVELS OF IGF-1,STREM-1 AND MBP AND PROGNOSIS IN NEONATES WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY

目的探讨脑苷肌肽注射液联合加热湿化高流量鼻导管通气在新生儿缺氧缺血性脑病(HIE)治疗中的临床应用价值。方法选取2014年12月—2017年12月该院103例HIE患儿,按照随机数字表法分为观察组(n=52)与对照组(n=51)。常规治疗基础上给予脑苷肌肽注射液治疗,同时对照组予以常规通气干预,观察组给予加热湿化高流量鼻导管通气。对比二组临床疗效、临床症状及体征改善情况、治疗前后血清因子[胰岛素样生长因子-1(IGF-1)、可溶性髓系细胞触发受体-1(sTREM-1)、髓鞘碱蛋白(MBP)]水平、神经行为功能(NBNA评分),治疗结束后随访12个月,统计对比二组预后情况。结果 (1)临床疗效:观察组治疗总有效率82.69%(43/52)高于对照组62.75%(32/51)(P<0.05);(2)症状、体征改善情况:观察组惊厥、嗜睡、过度兴奋神经症状消失时间及意识、吮吸、反射、肌张力恢复时间短于对照组(P<0.05);(3)血清因子水平:治疗前二组血清IGF-1、sTREM-1、MBP水平差异无统计学意义(P>0.05),治疗后观察组血清IGF-1水平高于对照组,sTREM-1、MBP水平低于对照组(P<0.05);(4)神经行为功能:治疗后观察组NBNA行为能力、主动肌张力、被动肌张力、原始反射、一般反应各项评分及总分高于对照组(P<0.05);(5)预后:治疗结束后随访12个月,观察组智力低下9.62%(5/52)、运动/语言障碍发生率11.54%(6/52)低于对照组27.45%(14/51)、31.37%(16/51)(P<0.05),二组脑瘫及癫发生率比较差异无统计学意义(P>0.05)。结论脑苷肌肽注射液联合加热湿化高流量鼻导管通气治疗HIE,效果显著,可有效促进临床症状及体征缓解、恢复,并改善患儿神经行为功能,降低智力低下、语言/运动障碍等后遗症发生率,可能与该治疗方案能调节疾病相关因子表达有关。

Objective To explore the application value of cattle encephalon glycoside and ignotin injection combined with high flow nasal catheter ventilation with heated humidification in neonates with hypoxic- ischemic encephalopathy（HIE）. Methods From December 2014 to December 2017, 103 children with HIE in our hospital were randomly divided into observation group （n = 52） and control group （n = 51）. On the basis of routine treatment, two groups were treated with cattle encephalon glycoside and ignotin injection. At the same time, the control group received routine ventilation intervention, and the observation group was given high flow nasal catheter ventilation with heated humidification. The clinical effects, clinical symptoms and signs, the serum factors [insulin- like growth factor - 1 （IGF- 1）, soluble myelocytic trigger receptor - 1 （sTREM-1）, myelin alkali protein （MBP）] and neurobehavioral function （NBNA score） before and after treatment were compared between the two groups. After 12 months of treatment, the prognosis of the two groups was statistically compared. Results { 1） Clinical efficacy： the total effective rate of the observation group was 82.69%0 （43/52）, higher than that of the control group 62.75% （32/51） （P〈0.05）. （2） Improvement of symptoms and signs： the disappearance time of the symptoms of convulsion, lethargy and excitability of the observation group and the recovery time of consciousness, sucking, reflex and muscle tension were shorter than those of the control group（P〈0.05）. （3） Serum factor level： there was insignificant difference in serum levels of IGF- 1, sTREM- i and MBP between the two groups before treatment（P〈 0.05 ）. After treatment, the serum level of IGF- 1 of the observation group was higher than that of the control group, while the levels of sTREM- 1 and MBP were lower than those of the control group（P%0.05）. （4） Neurobehavioral function： after treatment, the scores of NBNA behavior, active muscle tension, passive muscle tension, primordial reflex, general response and total score were higher in the observation group than those in the control group（P〈0.05）. （5） Prognosis： 12 months of followup after treatment, the rate of mental retardation 9.62% （5/52）, motor / language disorder 11.54% （6/52） in the observation group was lower than that in the control group [27.45% （14/51）, 31.37% （16/51）]（P〈0.05）. There was no significant difference in incidence of cerebral palsy and epilepsy between the two groups（P〈0.05）. Conclusion The effect of cattle encephalon glycoside and ignotin injection combined with hyperthermia and high flow nasal catheter ventilation with heated humidification on HIE has significant effect. It can effectively promote the relief and recovery of clinical symptoms and signs, improve the neurobehavioral function of children, reduce the incidence of mental retardation, language / dyskinesia and other sequelae, and it may be related to the regulation of disease related factors by the therapy.