高压氧联合重组人促红素治疗新生儿缺氧缺血性脑病临床疗效观察

Clincical obserration of hyperbaric oxygen combined with recombinant human erythropoietin in neonates with hypoxic-ischemic encephalopathy

目的探讨高压氧(HBO)联合重组人促红素注射液治疗新生儿缺氧缺血性脑病(HIE)的疗效及其对半胱氨酸天冬氨酸蛋白(caspase-3)和内源性激活素A(ACTA)表达水平的影响.方法选取2015年10月至2017年5月青岛市中心医院小儿科收治的76例HIE患儿,采用随机数字表法分为观察组和对照组,每组38例.对照组患儿在常规治疗的基础上给予HBO治疗,观察组患儿对照组治疗的基础上给予重组人促红素注射液治疗.治疗10 d后对患儿疗效进行评估;在治疗前及治疗后5、10 d使用新生儿神经行为测定(NBNA)评分对患儿进行评测,记录神经反射恢复时间和意识恢复时间;采用酶联免疫吸附(ELISA)法测定患者治疗前后血清中caspase-3及ACTA含量;记录2组患儿不良反应发生情况.结果观察组患儿治疗总有效率(89.47%)明显高于对照组(71.05%),差异有统计学意义(P<0.05).2组患儿治疗后5、10 d新生儿神经行为测定(NBNA)评分均高于治疗前,且观察组明显高于对照组(P<0.05或P<0.01);观察组患儿神经反射恢复时间和意识恢复时间均短于对照组(P<0.05);治疗后5d2组患儿caspase-3水平明显高于治疗前,并且观察组明显低于对照组(P<0.05),而治疗后10d2组患儿血清caspase-3水平较治疗后5d均明显降低,并且观察组明显低于对照组(P<0.05);2组患儿治疗后5、10 d血清ACTA水平均高于治疗前,并且观察组明显低于对照组(P<0.05).结论 HBO联合重组人促红素注射液治疗HIE临床疗效优于单纯HBO治疗,并可下调血清caspase-3、ACTA的表达,抑制细胞凋亡,促进细胞修复,减轻神经损伤.

Objective To investigate the efficacy of hyperbaric oxygen (HBO) combined with recombinant human erythropoietin injection on neonatal hypoxic-ischemic encephalopathy (HIE),and the effects on the expression levels of cysteine aspartic protease-3 (caspase-3) and endogenous activin A (ACT A).Methods eventy-six child patients with HIE admitted to the Department of Pediatrics of the hospital from October 2015 to May 2017 were enrolled for the study,and were randomly divided into the observation group and the control group,each consisting of 38 patients.The patients in the control group received HBO therapy on the basis of conventional treatment,while the patients in the observation group had human erythropoietin injection in addition to the treatment received by the control group.After 10 days of treatment,treatment efficacy was evaluated for the 2 groups.After 5 and 10 days of treatment,the neonatal behavioral neurological assessment (NBNA) scores were evaluated,and nerve reflex recovery time and conscious recovery time for the patients of the 2 groups were recorded.The levels of serum caspase-3 and ACT A in the patients of the 2 groups were measured by enzyme-linked immunosorbent assay (ELISA),and adverse reactions of the two groups were recorded as well.Results Total efficacy rate for the observation group (89.47%)was significantly higher than that for the control group (71.05 %)(P < 0.05),After 5 and 10 days of treatment,the NBNA scores of the 2 groups were all significantly higher than those before treatment and the NBNA scores of the observation group were significantly higher than those before treatment,and the NBNA scores of the observation group were also obviously higher than those of the control group (P < 0.05 or P < 0.01).After treatment,the nerve reflex recovery time and conscious recovery time of the observation group were all shorter than those of the control group (P < 0.05).After 5 days of treatment,the caspase-3 levels of the two groups were significantly higher than those before treatment,and that of the observation group was obviously lower than that of the control group (P <0.05).However,after 10 days of treatment,the caspase-3 levels in the 2 groups all decreased markedly,as compared with those after 5 days of treatment,and.that of the observation group was obviously lower than that of the control group (P < 0.05).Conclusion HBO combined with recombinant human erythropoietin injection was superior to simple HBO therapy in the treatment of HIE,and could down-regulate the expression levels of Caspase-3 and ACT A,inhibit cell apoptosis,promote cell repair and ultimately lessen nerve damage.