窒息早产儿有核红细胞变化与缺氧性脑损害的相关性研究

Correlation between NRBC level and hypoxic brain damage in preterm infants with asphyxia

目的:探讨窒息对早产儿血常规中红细胞参数的影响,以及有核红细胞(NRBC)在窒息早产儿中是否具有预测早产儿缺氧性脑损伤程度及预后的作用。方法:选择2015年6月至2017年5月入住我院新生儿科的窒息早产儿伴脑损伤的为观察组(n=50,MRI确认),窒息早产儿无脑损伤组(n=30),无窒息早产儿20例为对照组(n=20)。三组患儿均在生后的不同时间点进行血常规红细胞参数检测、MRI、振幅整合脑电图和头颅彩色多普勒检查。动态观察窒息早产儿脑损害预后情况。结果:观察组与对照组相比较,红细胞总数(RBC)、HGB、HCT差异无统计学意义(P>0.05);观察组NRBC及NRBC%显著高于对照组(P<0.05);振幅整合脑电图EEG连续性(Co)、睡眠觉醒周期(Cy)和下边缘振幅值(LB)显著低于对照组(P<0.05),观察组脑血流速度显著低于对照组(P<0.05),NRBC参数在窒息早产儿出生后12个月基本恢复正常(P<0.05),脑损伤发生百分率显著下降(P<0.05),NRBC升高程度与窒息程度成正相关。结论:窒息早产儿初生血常规红细胞参数NRBC升高程度与窒息程度成相关;窒息早产儿NRBC恢复正常的时间与头颅影像学及脑电图异常恢复时间成正相关,可以作为预测脑损伤程度及预后的评估指标。

Objective: To investigate the effect of asphyxia on erythrocyte parameters in preterm infants, and whether nucleated red blood cells(NRBC) can predict hypoxic brain damage and prognosis in premature infants. Methods: Fifity asphyxia premature infants with brain injury and 30 asphyxia premature infants without brain injury were selected as observation group, and 20 preterm infants as control group from June 2015 to May 2017. Blood routine red blood cell parameters were detected at different time points in the two groups. We also had MRI, amplitude integrated electroencephalogram and head color Doppler examination. The brain damage in preterm infants was observed dynamically. Results: The number of red blood cells(RBC), HGB, HCT had no statistical significance between the observation group and the control group(P>0.05). NRBC and NRBC% of the observation group were significantly higher than that in the control group(P<0.05);Amplitude integrated electroencephalogram(Co) EEG continuity, sleep wake cycle(Cy) and edge amplitude(LB) of the observation group were significantly lower than the control group(P<0.05). The cerebral blood flow velocity of the observation group was significantly lower than that of the control group(P<0.05). The NRBC parameters returned to normal in 12 months after birth, and the percentage of brain injury decreased significantly(P<0.05). The increase of NRBC was positively correlated with the degree of asphyxia. The level of NRBC was positively correlated with the degree of asphyxia preterm infants. Conclusion: The degree of NRBC elevation in asphyxiated premature infants is associated with the degree of asphyxia. The time of NRBC returned to normal in asphyxia premature infants is positively correlated with the recovery time of cranial imaging and EEG abnormality. It can be used as an index to predict the degree and prognosis of brain injury.