血清BDNF在新生儿缺氧缺血性脑病亚低温治疗中的临床价值研究

Clinical value of serum BDNF in mild hypothermia treatment of neonatal hypoxic-ischemic encephalopathy

目的:探讨脑源性神经营养因子(BDNF)在新生儿缺氧缺血性脑病(HIE)亚低温治疗的临床价值。方法:选取2018年5月至2022年4月在天津医科大学第二医院新生儿科无HIE的20名健康婴儿为对照组,接受亚低温治疗的90例HIE患儿为研究组(中度HIE患儿48例,重度HIE患儿42例)。分别于治疗前(生后1 h)、治疗后第3天及第7天测定患儿BDNF、肌酸磷酸激酶(CK)和肌酸激酶同工酶MB(CK-MB)水平及治疗后第3天酸碱度(PH)值、碱剩余(BE)值。结果:BDNF在重度HIE患儿中水平显著高于中度组(t=8.56,P<0.01),中度和重度HIE患儿的亚低温疗效分别为95.8%和66.7%,亚低温治疗后神经异常组或死亡组BDNF水平明显高于改善组。对于中度HIE患儿,亚低温治疗后3 d和7 d与出生后1 h相比,血清CK-MB和CK水平均显著降低(F=66.35、87.06,均P<0.01);重度HIE患儿经亚低温治疗后表现出相同的趋势(F=79.23、138.2,均P<0.01)。对于PH和BE,中度HIE患儿治疗3 d均较生后1 h升高,差异有统计学意义(t=14.05、25.201,均P<0.01);重度HIE患儿治疗后表现出相同的变化趋势(t=16.783、29.17,均P<0.01)。结论:血清BDNF水平可能成为亚低温治疗HIE患儿临床效果新的预测指标。

Objective:To investigate the clinical value of brain-derived neurotrophic factor(BDNF)of neonatal hypoxic-ischemic encephalopathy(HIE)with mild hypothermia treatment.Methods:Twenty healthy infants without HIE in the Department of Neonatology,the Second Hospital of Tianjin Medical University from May 2018 to April 2022 were selected as the control group,and 90 infants with HIE receiving mild hypothermia treatment were selected as the study group,including 48 infants with moderate HIE and 42 infants with severe HIE.The levels of BDNF,creatine phosphokinase(CK)and creatine kinase isoenzyme MB(CK-MB)were measured before treatment(1 hour after birth),on the 3rd day and the 7th day after treatment,and the PH value and base residual(BE)value were measured on the 3rd day after treatment.Results:The level of BDNF in children with severe HIE was significantly higher than that in the moderate group(t=8.56,P<0.01),and the efficacy of mild hypothermia in children with moderate and severe HIE was 95.8%and 66.7%,respectively.After mild hypothermia,the level of BDNF in the neurologic abnormality group or death group was significantly higher than that in the improvement group.For children with moderate HIE,serum CK-MB and CK levels were significantly decreased at the 3rd and the 7th day after mild hypothermia treatment compared with 1 hour after birth(F=66.35,87.06,both P<0.01).The children with severe HIE showed the same trend after mild hypothermia treatment(F=79.23,138.2,both P<0.01).The level of PH and BE in children with moderate HIE was higher at the 3rd day after treatment than at 1 hour after birth,and the difference was statistically significant(t=14.05,25.201,both P<0.01).The children with severe HIE showed the same trend after treatment(t=16.783,29.17,both P<0.01).Conclusion:The level of serum BDNF may be a new predictor of clinical efficacy in mild hypothermia treatment of HIE infants.