新生儿窒息脑脊液血栓素A_2及前列环素的变化及其临床意义

Concentration changes of thromboxane A_2 and prostacyclin in cerebrospinal fluid and clinical significance in asphyxiated new-boras

目的 探讨窒息新生儿脑脊液(CSF)中血栓素A2(TXA2)、前列环素(PGI2)的浓度变化及与脑损伤的关系。方法36例足月新生儿中中、重度缺氧缺血性脑病(HIE)12例,轻度HIE13例,对照组11例。生后36～72h取CSF和血液测定TXB2(TXA2之代谢产物)及6-K-PGF1α(PGI2之代谢产物)浓度(放免法)。结果中、重度HIE组CSF中TXB2及6-K-PGF1α浓度最高(206.06±29.74ng/L,168.47±23.02ng/L),轻度组次之(83.37±28.57ng/L,131.42±16.75ng/L),对照组最低(41.77±21.58ng/L,86.23±13.05ng/L),经方差分析有非常显著意义(P<0.01);血浆TXB2及6-K-PGF1α浓度变化有同样趋势,但轻度HIE组与对照组差异无统计学意义(P>0.05)。结论 窒息后CSF中TXA2和PGI2是预示脑损伤的敏感指标。

Objective To investigate concentration changes of thromboxane A2(TXA2) and prostacyclin (PGI2) in cere-brospinal fluid(CSF) in the asphyxiated newborn and explore relationships between the level of them in CSF and hypoxic brain damage after neonatal asphyxia. Methods Thirty six full term newborns were divided into three groups: 12 with moderate-severe hypoxic-is-chemic encephalopathy (HIE), 13 with mild HIE, and 11 without HIE(control group). The levels of TXB2(TXA2 metabolite) and 6 keto-PGF1α(PGl2 metabolite) in CSF and plasma were measured during 36-72 hours after birth. Measurement of the levels in CSF and plasma were performed by RIA and expressed as ng/L(mean±SD). Results The levels of TXB2 and 6-keto-PGF1α in CSF in the moderate-severe HIE group(206.06±29.74,168. 47±23. 02, respectively) were significantly higher than those of the mild HIE group(83.37±28.57,131.42±16.75, respectively) (P<0.01) and the control group (41.77±21. 58, 86.23±13.05, respectively ) ( P< 0.01). The levels of TXB2 and 6-keto-PGF1α in plasma in the moderate -severe HIE group were also higher than those of the mild HIE group and the control group(P<0.01) ,but no significant difference was found between mild HIE group and the control group(P>0.05). Conclusion The concentration changes of TXB2 and 6-keto-PGF1α in CSF after neonatal asphyxia may be a sensitive marker of evaluating the severity of brain damage.