单唾液酸四己糖神经节苷脂联合鼠神经生长因子对新生儿缺氧缺血性脑病的临床研究

Clinical efficacy of monosialotetrahexose ganglioside combined with mouse nerve growth factor in the treatment of neonatal hypoxic ischemic encephalopathy

目的:探讨单唾液酸四己糖神经节苷脂(GM1)联合鼠神经生长因子(NGF)治疗新生儿缺氧缺血性脑病(HIE)的临床疗效及安全性。方法:纳入我院在2017年1月至2018年4月收治的HIE患儿122例,按照随机数字表法分为观察组和对照组(各61例),对照组给予单唾液酸四己糖神经节苷脂钠(20 mg+10%GS注射液30～50 mL中静脉滴注,每天一次);观察组给予单唾液酸四己糖神经节苷脂钠(20 mg+10%GS注射液30～50 mL中静脉滴注,每天一次)+鼠神经生长因子(18μg+2 mL注射用水,肌内注射,每天一次)治疗;两组患儿均连续治疗14 d;比较两组患儿临床疗效、神经功能、智能发育及运动发育情况;记录两组患儿意识反射、吸吮反射、肌张力恢复时间;测定两组患儿胰岛素样生长因子-1(IGF-1)、血清髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)、血管内皮生长因子(VEGF)及S-100β水平。结果:观察组临床有效率为93.44%(57/61),对照组为80.33%(49/61),差异有统计学意义(Z=4.604,P<0.05);观察组出生后28 d神经测定量表(NBNA)评分明显高于对照组(P<0.05),出生后3个月观察组智能发育指数(MDI)、精神运动发育指数(PDI)评分高于对照组(P<0.05);治疗期间观察组意识反射恢复时间、吸吮反射恢复时间及肌张力恢复时间明显短于对照组(P<0.05);两组患者治疗后IGF-1水平升高,MBP、NSE、VEGF及S-100β水平降低(P<0.05);治疗后观察组上述指标改善程度均优于对照组(P<0.05)。结论:GM1联合鼠神经生长因子治疗HIE疗效显著,能够明显改善患儿神经功能,缩短恢复时间,降低血清相关因子水平。

AIM:To investigate the clinical efficacy and safety of monosialotetrahexose ganglioside(GM1)combined with mouse nerve growth factor(NGF)in the treatment of neonatal hypoxic ischemic encephalopathy(HIE).METHODS:A total of 122 children with HIE admitted to our hospital from January 2017 to April 2018 were enrolled in the observation group and the control group(61 cases each)according to the random number table method.The control group was given monosialotetrahexosyl ganglioside sodium(20 mg+10%GS injection 30-50 mL,once a day),while the observation group was given mouse nerve growth factor sodium(20 mg+10%GS injection 30-50 mL,once a day)+mouse nerve growth factor(18μg+2 mL water for injection,intramuscular injection,once a day);two groups of children were treated for 14 days.The clinical efficacy,neurological function,mental development and motor development of two groups were compared.The conscious reflex,sucking reflex,and muscle tension recovery time of two groups were recorded.The determination of insulin-like growth factor-1(IGF-1),serum myelin basic protein(MBP),neuron specific enolase(NSE),vascular endothelial growth factor(VEGF)and S-100βlevels of two groups were detected.RESULTS:The clinical effective rate was 93.44%(57/61)in the observation group and 80.33%(49/61)in the control group.The difference was statistically significant(Z=4.604,P<0.05).The neurological measurement scale(NBNA)score of the observation group at 28 days after birth was significantly higher than that of the control group(P<0.05).The mental development index(MDI)and psychomotor development index(PDI)scores of the observation group were higher than those of the control group at 3 months after birth(P<0.05).During the treatment period,the recovery time of conscious reflex,the recovery time of sucking reflex and the recovery time of muscle tension were significantly shorter in the observation group than in the control group(P<0.05).The levels of IGF-1 were increased after treatment,and the levels of MBP,NSE,VEGF and S-100βwere decreased(P<0.05).The improvement of the above indicators in the observation group was better than that of the control group(P<0.05).CONCLUSION:GM1 combined with mouse nerve growth factor has a significant effect on the treatment of HIE,which can significantly improve the neurological function of children,shorten the recovery time and reduce the serum related factors.