氨茶碱对早产儿脑损伤潜在保护作用的回顾性研究

The potential protective effect of aminophylline on brain injury in premature infants:A retrospective study

目的本研究以脑损伤标志物神经元特异性烯醇化酶(neuron-specificenolase,NSE)作为脑损伤严重程度和恢复的生化指标,探讨氨茶碱的早期使用对改善早产儿脑损伤的临床疗效。方法回顾性收集2018年9月至2020年9月我院NICU收治的胎龄28~34周,且生后5 d内至少有2次NSE检验结果的早产儿临床资料,根据他们早期是否使用氨茶碱分为治疗组和对照组,采用GraphPadPrism 8.0.1统计软件进行分析,比较两组的NSE日均下降值。结果共有30例静脉滴注氨茶碱治疗的早产儿划分为治疗组,54例没有使用氨茶碱的早产儿划分为对照组。对比两组间5 d内的NSE每日平均下降幅度发现,治疗组NSE日均下降值(16.60±13.7)ng/mL显著比对照组的NSE日均下降值(5.91±4.71)ng/mL大(P <0.05)。根据首次NSE值的高低设亚组分析,在NSE> 60 ng/mL的潜在较重的脑损伤人群中,治疗组NSE的日均下降值(23.37±13.82)ng/mL显著比对照组(11.09±3.92)ng/mL的大(P <0.05)。而在NSE <60 ng/mL的较轻的脑损伤人群中,治疗组(6.45±3.62)ng/mL仍比对照组的NSE下降值(4.46±3.83)ng/mL大,差异无统计学意义(P=0.114)。结论早期静脉滴注氨茶碱对促进早产儿脑损伤的恢复具有积极作用,尤其是对于潜在较重的脑损伤患儿效果更佳。

Objective To investigate the clinical efficacy of early administration of aminophylline on improving brain injury in preterm infants by evaluating neuron-specific enolase(NSE). Methods Data of critical newborns admitted to NICU from September 2018 to September 2020 who had at least twice NSE test results within5 days after birth were collected. Results 30 newborns who were treated with intravenous aminophylline were classified into the treatment group,while 54 newborns who were untreated with aminophylline in the early stage were classified into the control group. The average daily decrease of the brain injury markers NSE between two groups was compared. Compared with the control group,the daily average decrease of NSE in the treatment group was significantly larger. In order to exclude the influence of confounding factors,the subgroup further analyzed that in the cases of severe brain injury with NSE > 60 ng/mL,the average daily decrease of NSE in the treatment group was still significantly larger than that in the control group. In the cases of mild brain injury with NSE <60 ng/mL,the average daily decrease of NSE in the treatment group was larger than that of the control group,however,there was no significantly difference. There was no significant difference in the overall incidence of adverse events between two groups. Conclusion Administration of aminophylline in the early stage is beneficial to the recovery of critical newborns brain injury,especially in the severe brain injury case.