鼠神经生长因子联合神经节苷脂治疗新生儿缺氧缺血性脑病的Meta-分析

Meta-analysis of Mouse Nerve Growth Factor combined with ganglioside in treatment of hypoxic-ischemic encephalopathy

目的系统评价鼠神经生长因子联合神经节苷脂治疗新生儿缺氧缺血性脑病(HIE)的疗效和安全性。方法计算机检索中国期刊全文数据库(CNKI)、维普中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库、Pub Med、EMbase等数据库,收集鼠神经生长因子联合神经节苷脂治疗新生儿HIE的随机对照研究,提取资料并评价质量后,采用Rev Man 5.1软件进行Meta-分析。结果共纳入8篇文献,716例患儿;Meta-分析结果显示,与单用神经节苷脂比较,鼠神经生长因子联合神经节苷脂:显著提高临床有效率[RR=1.32,95%CI(1.22,1.43),P<0.01]和NBNA评分[MD=4.00,95%CI(3.54,4.46),P<0.01];显著缩短意识恢复时间[MD=-1.74,95%CI(-2.44,-1.04),P<0.01]、惊厥消失时间[MD=-1.47,95%CI(-1.88,-1.06),P<0.01]、肌张力恢复时间[MD=-2.73,95%CI(-3.19,-2.28),P<0.01]和反射恢复时间[MD=-2.57,95%CI(-3.32,-1.82),P<0.01];显著降低血清神经元特异性烯醇化酶(NSE)[MD=-5.04,95%CI(-6.26,-3.82),P<0.01]和血管内皮生长因子(VEGF)[MD=-29.63,95%CI(-33.11,-26.16),P<0.01];显著提高智力发育指数(MDI)[MD=8.87,95%CI(7.92,9.82),P<0.01]和心理运动发育指数(PDI)[MD=9.89,95%CI(8.52,11.27),P<0.01]。结论鼠神经生长因子联合神经节苷脂对新生儿HIE受损脑神经元及神经胶质细胞神经元功能具有协同修复作用,与协同降低血清NSE和VEGF水平有关。

Objective To evaluate the efficacy and safety of mouse nerve growth factor（MNGF） and ganglioside in treatment of neonatal hypoxic-ischemic encephalopathy（HIE）. Methods Randomized controlled trials（RCT） and cohort studies about MNGF combined with ganglioside in the treatment of neonatal HIE were retrieved from Pub Med, Embase, CNKI, VIP, CBM and Wangfang databases. Meta-analysis was performed by using Rev Man 5.3 software after data extraction and quality evaluation. Results Totally eight RCTs and 716 patients were included. Meta-analysis showed that, compared with ganglioside alone, MNGF combined with ganglioside significantly improved the clinical efficiency [RR = 1.32, 95%CI（1.22,1.43）, P〈0.01] and NBNA scores [MD = 4.00, 95%CI（3.54, 4.46）, P〈0.01] after treatment; It significant reduced the conscious recovery time [MD =-1.74, 95%CI（-2.44,-1.04）, P〈0.01], convulsant disappearance time [MD =-1.47, 95%CI（-1.88,-1.06）, P〈0.01], muscle tone recovery time [MD =-2.73, 95%CI（-3.19,-2.28）, P〈0.01], and reflex recovery time [MD =-2.57, 95%CI（-3.32,-1.82）, P〈0.01]; It significantly lowered NSE levels [MD =-5.04, 95%CI（-6.26,-3.82）, P〈0.01] and VEGF levels [MD=-29.63,95%CI（-33.11,-26.16）, P〈0.01]; It significantly increased MDI levels（MD = 8.87, 95%CI（7.92, 9.82）, P〈0.01] and PDI levels [MD = 9.89, 95%CI（8.52, 11.27）, P〈0.01]. Conclusion MNGF combined with gangliosides have a synergistic recovery effect on the neuronal function of neurons and glial cells in neonates with HIE, which is related to the synergistic reduction of serum NSE and VEGF levels.