强化神经营养方案对脑病患儿脑血流灌注及神经生长因子的影响
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摘要
目的观察强化神经营养方案对缺氧缺血性脑病康复期患儿脑血流灌注指标及相关神经生长因子水平的影响。方法选取2015年6月～2016年6月于本院确诊为缺氧缺血性脑病的68例足月儿为研究对象,应用随机数表法将68例患儿分为观察组(强化神经营养方案组)和对照组(常规神经营养方案组),每组各34例。对照组患儿在常规治疗基础上采用鼠神经生长因子注射液治疗,每日30μg,观察组患儿在对照组基础上加入注射用单唾液酸四己糖神经节苷脂钠治疗,每日20mg,两组患儿均连续治疗3周。观察患儿的脑血流灌注指标和相关神经生长因子水平变化。结果治疗后观察组患儿的P S V、 E D V均高于对照组患儿, R I低于对照组,两组患儿的P S V、 E D V以及R I等血流灌注指标情况的差异均有统计学意义(P <0.05)。观察组患儿治疗后NANA评分高于对照组,差异有统计学意义(P <0.05)。观察组患儿的NGF水平高于对照组,MBP、BNP水平低于对照组,差异均有统计学意义(P <0.05)。结论强化神经营养方案治疗康复期的缺氧缺血性脑病患儿不仅能提高NGF水平,降低MBP和BNP水平,还能改善患儿的脑血流灌注指标,具有更明显的营养神经作用。
Objective To observe the effect of intensive neurotrophic regimen on cerebral blood perfusion index and related nerve growth factor levels in children with hypoxic-ischemic encephalopathy(HIE) at convalescence stage.Methods 68 full-term infants who undergoing hypoxic ischemic brain in our hospital were selected from June 2015 to June 2016. According to the random number table,68 cases were divided into observation group(enhanced neurotrophic group)and control group(conventional neurotrophic group),3 4 cases in each group. The control group in the conventional treatment wasbased on the use of mouse nerve growth factor injection,daily 30 g,the observation group patients wastreated monosialo four hexose ganglioside sodium for injection treatment,daily 20 mg,on the basis ofcontrol group,two groups were treated continuously for 3 weeks.The changes of cerebral blood perfusion index and related nerve growth factor levels were observed. Results After treatment,the PSV and EDV in the observation group were higher than those in the control group,and RI was lower than that in the control group,and the differences in the blood perfusion indexes of PSV,EDV and RI between the two groups were statistically significant(P <0.05). The score of NANA in the observation group was higher than that in the control group,the difference was statistically significant(P <0.05). The level of NGF in the observation group was higher than that in the control group,and the levels of MBP and BNP were lower than those of the control group,the difference was statistically significant(P <0.05).Conclusions Enhancement of hypoxic ischemic encephalopathy nerve rehabilitation treatment scheme can not only improve the level of NGF,decrease MBP and BNP level,but also improve the index of children with cerebral perfusion,with neurotrophic action more obvious.
Objective To observe the effect of intensive neurotrophic regimen on cerebral blood perfusion index and related nerve growth factor levels in children with hypoxic-ischemic encephalopathy(HIE) at convalescence stage.Methods 68 full-term infants who undergoing hypoxic ischemic brain in our hospital were selected from June 2015 to June 2016. According to the random number table,68 cases were divided into observation group(enhanced neurotrophic group)and control group(conventional neurotrophic group),3 4 cases in each group. The control group in the conventional treatment wasbased on the use of mouse nerve growth factor injection,daily 30 g,the observation group patients wastreated monosialo four hexose ganglioside sodium for injection treatment,daily 20 mg,on the basis ofcontrol group,two groups were treated continuously for 3 weeks.The changes of cerebral blood perfusion index and related nerve growth factor levels were observed. Results After treatment,the PSV and EDV in the observation group were higher than those in the control group,and RI was lower than that in the control group,and the differences in the blood perfusion indexes of PSV,EDV and RI between the two groups were statistically significant(P <0.05). The score of NANA in the observation group was higher than that in the control group,the difference was statistically significant(P <0.05). The level of NGF in the observation group was higher than that in the control group,and the levels of MBP and BNP were lower than those of the control group,the difference was statistically significant(P <0.05).Conclusions Enhancement of hypoxic ischemic encephalopathy nerve rehabilitation treatment scheme can not only improve the level of NGF,decrease MBP and BNP level,but also improve the index of children with cerebral perfusion,with neurotrophic action more obvious.
引文
1杨萍,赵泽宇.神经行为发育监测及早期干预对新生儿智能发育的影响[J].检验医学与临床,2015, 12(9):1203-1204.
2丁玉红,闫俊梅,闫静.三磷酸胞苷二钠联合鼠神经生长因子治疗新生儿缺氧缺血性脑病的疗效观察[J].现代药物与临床,2015,30(10):1268-1271.
3覃丽霞.新生儿缺氧缺血性脑病的发病机制及治疗进展[J].中国中西医结合儿科学,2013,5(6):520-522.
4曾庆煌,曾仁和.重组人促红细胞生成素联合外源性单唾液酸四己糖神经节苷脂治疗重度新生儿缺氧缺血性脑病的疗效究[J].中华实用儿科临床杂志,2016,31(20):1582-1583.
5卫生部新生儿疾病重点实验室,复旦大学附属儿科医院,《中国循证儿科杂志》编辑部,GRADE工作组中国中心.足月儿缺氧缺血性脑病循证治疗指南(2011标准版)[J].中国循证儿科杂志,2011,6(5):327-335.
6中国医师协会新生儿专业委员会神经专家委员会.新生儿缺氧缺血性脑病超声诊断建议[J].中华神经医学杂志,2012, 11(4):413-415.
7陈小娟,冯茂霭,梁煜潮,等.促红细胞生成素联合单唾液酸四己糖神经节苷脂治疗新生儿缺氧缺血性脑病的效果[J].广东医学,2017,38(5):784-789.
8陈淑媛.缺氧缺血性脑病患儿大脑中动脉血流变化与脑损伤程度的关系[J].临床和实用医学杂志,2017, 16(3):249-252.
9陈凤飞.新生儿缺氧缺血性脑病血清NSE与TNF a、IL 6指标检测的临床意义[J].中西医结合心脑血管病杂志,2016, 14(14):1674-1676.
10黄鹏飞.单唾液酸四己糖神经节苷脂钠与胞二磷胆碱治疗轻中度新生儿缺血缺氧性脑病的效果[J].当代医药论丛,2017,15(1):26-28.
11韩金芬.单唾液酸神经节苷脂注射液治疗新生儿缺氧缺血性脑病的临床疗效及安全性[J].中国实用神经疾病杂志,2016, 19(16):130-131.
12 Kim M S, Shutov L P, Gnanasekaran A, et al. Nerve growth factor(NGF)regulates activity of nuclear factor of activated T-cells(NEAT)in neurons via thephosphatidylinositol 3-kinase(PI3K)-Aktglycogen synthase kinase 3β(GSK3β)pathway[J].J Biol Chem, 2014, 289(45):31349-31360.
13孟卫霞,黄莉芬.缺氧缺血性脑病患儿血流动力学及血清神经生长因子、髓磷脂碱性蛋白、脑钠肽水平变化[J].中国临床医生杂志,2017,45(2):100-102.
2丁玉红,闫俊梅,闫静.三磷酸胞苷二钠联合鼠神经生长因子治疗新生儿缺氧缺血性脑病的疗效观察[J].现代药物与临床,2015,30(10):1268-1271.
3覃丽霞.新生儿缺氧缺血性脑病的发病机制及治疗进展[J].中国中西医结合儿科学,2013,5(6):520-522.
4曾庆煌,曾仁和.重组人促红细胞生成素联合外源性单唾液酸四己糖神经节苷脂治疗重度新生儿缺氧缺血性脑病的疗效究[J].中华实用儿科临床杂志,2016,31(20):1582-1583.
5卫生部新生儿疾病重点实验室,复旦大学附属儿科医院,《中国循证儿科杂志》编辑部,GRADE工作组中国中心.足月儿缺氧缺血性脑病循证治疗指南(2011标准版)[J].中国循证儿科杂志,2011,6(5):327-335.
6中国医师协会新生儿专业委员会神经专家委员会.新生儿缺氧缺血性脑病超声诊断建议[J].中华神经医学杂志,2012, 11(4):413-415.
7陈小娟,冯茂霭,梁煜潮,等.促红细胞生成素联合单唾液酸四己糖神经节苷脂治疗新生儿缺氧缺血性脑病的效果[J].广东医学,2017,38(5):784-789.
8陈淑媛.缺氧缺血性脑病患儿大脑中动脉血流变化与脑损伤程度的关系[J].临床和实用医学杂志,2017, 16(3):249-252.
9陈凤飞.新生儿缺氧缺血性脑病血清NSE与TNF a、IL 6指标检测的临床意义[J].中西医结合心脑血管病杂志,2016, 14(14):1674-1676.
10黄鹏飞.单唾液酸四己糖神经节苷脂钠与胞二磷胆碱治疗轻中度新生儿缺血缺氧性脑病的效果[J].当代医药论丛,2017,15(1):26-28.
11韩金芬.单唾液酸神经节苷脂注射液治疗新生儿缺氧缺血性脑病的临床疗效及安全性[J].中国实用神经疾病杂志,2016, 19(16):130-131.
12 Kim M S, Shutov L P, Gnanasekaran A, et al. Nerve growth factor(NGF)regulates activity of nuclear factor of activated T-cells(NEAT)in neurons via thephosphatidylinositol 3-kinase(PI3K)-Aktglycogen synthase kinase 3β(GSK3β)pathway[J].J Biol Chem, 2014, 289(45):31349-31360.
13孟卫霞,黄莉芬.缺氧缺血性脑病患儿血流动力学及血清神经生长因子、髓磷脂碱性蛋白、脑钠肽水平变化[J].中国临床医生杂志,2017,45(2):100-102.