rhEPO联合鼠NGF治疗新生儿缺氧缺血性脑病的疗效与作用机制初探

Therapeutic effect and mechanism of recombinant human erythropoietin combined with mouse nerve growth factor on neonatal hypoxic-ischemic encephalopathy

目的 分析重组人促红细胞生成素(rhEPO)联合鼠神经生长因子(NGF)治疗新生儿缺氧缺血性脑病(HIE)的疗效与作用机制,并分析相关影响因素。方法 选取50例HIE患者作为研究对象,根据随机数字表法将其分为对照组和观察组,各25例。其中对照组给予常规疗法,观察组在此基础上给予rhEPO(200 U/kg·d,首次皮下注射,第2次开始静脉注射,每天1次)和鼠NGF(30μg加入2 mL注射用水,静脉注射,每天1次),2组患者均连续治疗10 d。比较2组临床疗效及血清神经元特异性烯醇化酶(NSE)、S100B蛋白、髓鞘碱性蛋白(MBP)水平、神经测定评分(NBNA评分)和治疗不良反应情况,并用Logistic多因素回归模型分析影响新生儿HIE疗效的因素。结果 观察组临床疗效优于对照组,其总有效率明显高于对照组,差异均有统计学意义(P<0.05);治疗后,观察组患儿血清NSE、S100B和MBP水平明显低于对照组,差异有统计学意义(P<0.05);有效者治疗前血清NSE、S100B和MBP明显低于无效者,差异有统计学意义(P<0.05);治疗后第5天及第10天,观察组NBNA评分明显高于对照组,且差异有统计学意义(P<0.05);经Logistic多因素回归分析模型,发现HIE严重程度和治疗方法是影响新生儿HIE疗效的独立因素(P<0.05)。结论 与常规治疗相比,重组人促红细胞生成素联合鼠神经生长因子治疗新生儿HIE安全性高,临床疗效显著提高,神经行为改善明显,可能与其对NSE、S100B和MBP影响相关。

Objective To analyze the efficacy and mechanism of recombinant human erythropoietin(rhEPO)combined with rat nerve growth factor(NGF)in the treatment of neonatal hypoxic-ischemic encephalopathy(HIE),and to analyze the related influencing factors.Methods Fifty patients were selected as the study subjects.They were divided into control group and observation group according to random number table method,with 25 cases in each group.The control group was given routine therapy,while the observation group was given rhEPO(200 U/kg.d,first subcutaneous injection,second intravenous injection,once a day)and rat NGF(30μg,2 mL water injection,intravenous injection,once a day);Both groups were treated for 10 days.The clinical efficacy,serum levels of neuron specific enolase(NSE),S100B protein,myelin basic protein(MBP),nerve test score(NBNA score)and adverse reactions were compared between the two groups.The factors influencing the efficacy of neonatal HIE were analyzed by logistic multivariate regression model.Results The clinical efficacy of the observation group was better than that of the control group,and the total effective rate was significantly higher than that of the control group,with statistical significance(P<0.05).After treatment,the levels of serum NSE,S100B and MBP in the observation group were significantly lower than those in the control group(P<0.05).Serum NSE,S100B and MBP in the effective group were significantly lower than those in the ineffective group before treatment,with statistical significance(P<0.05).On the 5th and 10th day after treatment,the NBNA score of the observation group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).The logistic regression analysis model found that the severity of HIE and treatment methods were independent factors affecting the efficacy of neonatal HIE(P<0.05).Conclusion Compared with routine treatment,recombinant human erythropoietin combined with mouse nerve growth factor has higher safety and clinical efficacy in the treatment of neonatal HIE,and the neurobehavioral improvement is obvious,which may be related to its effects on NSE,S100B and MBP.