Clinical Implication of the Changes of cAMP, TXA_2 and PGI_2 in CSF of Asphyxiated Newborns

To evaluate the changes of 3', 5'-cyclic adenosine monophosphate (cAMP), thrombox-ane A2(TXA2) and prostacyclin (PGI2) in cerebrospinal fluid (CSF) in the asphyxiated newborn and explore their roles in hypoxic-ischamic brain damage (HIBD). Thirty-six full term newborns were divided into 3 groups, including 12 with moderate-severe hypoxic-ischaemic encephalopathy (HIE), 13 with mild HIE, 11 without HIE (control group). The levels of cAMP, TXB2(TXA2 metabolite) and 6-keto-PGF1α(PGI2 metabolite) in CSF and plasma were measured 36-72 h after birth by RIA, and the concentrations were expressed as nM/L (cAMP), ng/L(TXB2 and 6-keto-PGF1α). The infants were followed-up at 6 and 12 month of age and Mental Development Index (MDI) and Psychomotor Development Index (FDD were measured using Bayley Scales of Infant Development (BSID). The CSF cAMP level in moderate-severe HIE group was 8. 60±2. 40, significantly lower than that of the mild HIE group (14. 83±2. 84) and the control group (24. 43±2. 39)(for both P<0. 01). The levels of TXB2 and 6-keto-PGF1α in CFS in the moderate-severe HIE group (206. 06±29. 74, 168. 47± 23. 02, respectively) were significantly higher than in the mild HIE group (83. 37±28. 57, 131. 42± 16. 57, respectively, P<0. 01) and the control group (41. 77±21. 58, 86. 23±13. 05, respectively, P<0. 01). The level changes of cAMP,TXB2 and 6-keto-PGF1α in plasma in all groups were similar to those in CSF, but no significant difference was found between mild HIE group and the control group (P>0. 05). The follow-up results showed that MDI and PDI of the moderate-severe HIE group were the lowest (84. 79±13. 34, 83. 50±13. 28, respectively), followed by mild HIE group (102.19±7. 02, 99. 94±9. 08, respectively) , with the control group being the highest (116. 63± 12.08, 116. 69±10. 87, respectively). Univariate analysis showed some significant difference (the moderate-severe HIE group vs. the mild HIE group or the control group, P<0. 01; the mild HIE group vs. the control group P<0. 05). The results suggested that the concentration of cAMP, TXA2 and T/K ratio in CSF after neonatal asphyxia might be sensitive markers in evaluating the severity of brain damage in early stage and predicting the future outcome.

正常足月新生儿生后7d内血清总胆红素的动态变化及其影响因素分析

目的 探讨石家庄地区正常足月新生儿血清总胆红素的动态变化，分析影响新生儿高胆红素血症的相关高危围产因素。方法 选取2002年1月至2006年1月在我院产科出生的正常足月新生儿和有产科高危因素的新生儿作为研究对象，应用微量胆红素测定仪测定各研究对象生后7d内不同时间点的末梢血总胆红素水平并分析各围产因素对新生儿黄疸的影响。结果 末梢血总胆红素于生后108h达峰值，平均为（266．6±92．9）μmol／L，第95百分位数为317．5μmol／L，随后胆红素水平缓慢下降。剖宫产、母分娩应用催产素、开奶时间延迟、首次胎粪排出延迟、红细胞增多症、低血糖者末梢血总胆红素峰值显著高于对照组（P均〈0．05）；宫内窘迫史、Apgar评分异常、体内出血、使用抗生素等围产因素对血清胆红素水平无明显影响（P均〉0．05）。结论 河北地区正常足月新生儿总胆红素峰值明显高于生理性黄疸高限；严格掌握剖宫产指征，减少催产素的应用，早期喂养，及时处理新生儿胎粪排出延迟、红细胞增多症和低血糖，也许可以有效地减少新生儿高胆红素血症的发生。