重组人促红细胞生成素对缺氧缺血性脑病新生儿心肌损伤的保护作用

Protective Effects of Recombinant Human Erythropoietin on Myocardial Injury in Neonates with Hypoxic-Ischemic Encephalopathy

目的:探讨重组人促红细胞生成素(rHuEPO)对缺氧缺血性脑病(HIE)新生儿心肌损伤的保护作用,并分析其可能机制。方法:选取2018年5月至2021年5月唐山市妇幼保健院收治的100例HIE新生儿,依据随机数表法分为对照组和观察组各50例。对照组实施常规治疗,观察组在对照组治疗基础上加用rHuEPO,共治疗2周。于治疗2周时观察两组患儿临床疗效;于治疗前、治疗2周时,检测两组患儿心肌营养因子-1(CT-1)、肌红蛋白(Myo)、心肌肌钙蛋白I(cTnI)等心肌损伤相关指标,谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、晚期蛋白氧化产物(AOPP)、活性氧(ROS)等氧化应激相关指标,白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)、IL-10等炎症反应相关指标,神经元特异性烯醇化酶(NSE)、S-100β蛋白等脑损伤相关指标;记录两组患儿治疗期间不良反应发生情况。结果:治疗2周时,观察组治疗总有效率(90.00%)高于对照组(70.00%),差异有统计学意义(P<0.05);治疗2周时,两组患儿的CT-1、Myo和cTnI水平均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05);治疗2周时,两组患儿的GSH-Px、SOD水平均较治疗前升高,AOPP、ROS水平均较治疗前降低,且观察组GSH-Px、SOD水平高于对照组,AOPP、ROS水平低于对照组(P<0.05);治疗2周时,两组患儿的IL-6、TNF-α、IL-10水平均较治疗前降低,且观察组低于对照组(P<0.05);治疗2周时,两组患儿的NSE、S-100β蛋白水平均较治疗前降低,且观察组低于对照组(P<0.05);两组患儿治疗期间,均未见明显的不良反应发生。结论:rHuEPO可有效提高HIE患儿的治疗效果,且可通过改善氧化应激、炎症反应等途径保护心肌损伤,还可减轻患儿的脑神经损伤,安全性好。

Objective: To investigate the protective effects of recombinant human erythropoietin(rHuEPO) on myocardial injury in neonates hypoxic-ischemic encephalopathy(HIE), and to analyze its possible mechanism. Methods: One hundred children with HIE treated in Tangshan Maternal and Child Health Hospital from May 2018 to May 2021 were extracted to be divided into the control group and the observation group via the random number table, with 50 cases in each group. The control group was treated with routine treatment, while the observation group received rHuEPO based on the control group, with the treatment course of 2 weeks. After treatment of 2 weeks, the efficacy of both groups was observed. Indicators related to myocardial injury such as myocardial nutritional factor-1(CT-1), myoglobin(Myo) and cardiac troponin I(cTnI), oxidative stress such as glutathione peroxidase(GSH-Px), superoxide dismutase(SOD), advanced protein oxidation products(AOPP), reactive oxygen species(ROS), inflammatory response such as interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), IL-10, and brain injury such as neuron specific enolase(NSE) and S-100β protein before treatment and after treatment of 2 weeks were measured and compared between two groups. Adverse drug reactions of both groups during treatment were recorded. Results: After treatment of 2 weeks, the total effective rate in the observation group was higher than that in the control group, with statistically significant difference(P<0.05). After treatment of 2 weeks, the levels of CT-1, Myo and cTnI in both groups were lower than those before treatment, and the observation group was lower than the control group, with statistically significant difference(P<0.05). The levels of GSH-Px and SOD in both groups were higher than those before treatment, and the levels of AOPP and ROS were lower than those before treatment, the levels of GSH-Px and SOD in the observation group were higher than those in the control group, and the levels of AOPP and ROS in the observation group were lower than those in the control group, with statistically significant differences(P<0.05). After treatment of 2 weeks, the levels of IL-6, TNF-α and IL-10 in both groups were lower than those before treatment, and the observation group was lower than the control group, with statistically significant difference(P<0.05). After treatment of 2 weeks, the levels of NSE and S-100β protein in both groups were lower than those before treatment, and the observation group was lower than the control group, with statistically significant difference(P<0.05). No obvious adverse drug reactions were observed in both groups. Conclusion: rHuEPO can effectively improve the therapeutic effect of children with HIE, protect against myocardial injury by improving oxidative stress and inflammatory response, and reduce brain nerve injury in children with higher safety.