神经生长因子对缺氧缺血性脑损伤患者闪光视觉诱发电位的影响

背景闪光视觉诱发电位(flash-visualevoked potential,F-VEP)是目前儿科临床评估中枢神经系统功能状态的一项新的易行方法.目的探讨闪光视觉诱发电位(F-VEP),反映新生大鼠缺氧缺血性脑损伤(hypoxic-ischemicbrain damage,HIBD)的敏感性,研究神经生长因子(nerve growthfactor,NGF)对新生鼠缺氧缺血性脑损伤的保护作用,为新生儿HIBD的早期诊断与干预提供理论依据.设计完全随机设计,对照实验研究.地点与材料研究地点为南京医科大学第二附属医院儿科,生后7d SD大鼠来源于南京医科大学实验动物中心,共60只,体质量约14～18 g,雌雄不拘,饲养于屏障环境的SPF级实验动物.干预40只大鼠制成HIBD动物模型后随机分成两组HIBD模型未治疗组20只,HIBD模型NGF治疗组20只,另20只为正常对照组.主要观察指标观察正常对照组及HIBD后F-VEP改变;NGF对HIBD模型的新生大鼠体质量增长情况、死亡率、左右脑质量及F-VEP波形影响.结果HIBD模型NGF治疗组体质量增长(11.9±3.5)g,实验过程中死亡率为5%,患侧(左侧)脑质量(0.59±0.02)与未治疗组相比差异有显著意义(P均＜0.01);治疗组左右脑重量差异无显著意义,而未治疗组左右脑质量[(0.39±0.10)g,(0.57±0.05)g]差异的显著性意义(P＜0.01);HIBD后NGF治疗组与未治疗组即刻F-VEP潜伏期[(36.84±2.120)ms,(36.44±1.94)m]均较对照组(30.27±1.52)m明显延长(P＜0.01),波幅降低(P＜0.01);NGF未治疗组7d后与同期对照组相比F-VEP潜伏期[(48.17±2.08)m,(29.80±1.93)ms]明显延长,波幅降低[(3.75±0.69)mV,(4.22±0.87)mV](P均＜0.01);同期NGF治疗组与未治疗组相比F-VEP潜伏期(32.08±1.85,48.17±2.08)明显缩短,波幅升高[(3.97±0.75)mV,(2.75±0.69)mV,P均＜0.01].结论F-VEP主波潜伏期、波幅可较迅速反映HIBD后脑功能状态;NGF治疗减轻了HIBD后脑萎缩、改善了脑功能.

Impact of nerve growthfactor on flash-visual evoked potential in patients with hypoxic-ischemic brain damage

BACKGROUND: Flash-visual evoked potential(F-VEP) is a new easy practicable method in the clinical evaluation of the functional status of central nervous system in paediatrics at present.OBJECTIVE: To investigate the sensitivity of F-VEP in the reflection of hypoxic-ischemic brain damage(HIBD) in neonatal rats for studying the protective effect of nerve growth factor(NGF) on neonatal HIBD rats, which is aimed to provide a theoretical gist in early diagnosis and intervention in neonatal HIBD.DESIGN: A complete randomised controlled trial.SETTING and PARTICIPANTS: Study was conducted in the Department of Paediatrics of the Second Affiliated Hospital of Nanjing Medical University. A total of 60 7-day old SD rats in either gender with a mass from 14 g to 18 g were obtained from the experimental animal centre of Nanjing Medical University, which were SPF experimental animals fed in barrier environment.INTERVENTIONS: A total of 40 rats were randomly allocated into two groups after the establishment of HIBD animal model: HIBD model without treatment group(HIBD group, n=20) and HIBD model NGF treatment group(NGF group, n = 20) and another 20 rats were set in normal control group (control group).MAIN OUTCOME MEASURES: To observe the alteration of F-VEP in control group as well as after HIBD, and the impact of NGF on the increase of mass, mortality, brain weight of left and right side and F-VEP wave in neonatal HIBD rats.RESULTS: Rats in NGF group had an increase of( 11.9 ± 3.5) g in mass, the mortality rate was 5% during the study, and the brain weight of the HIBD side (left side) was(0. 59 ±0.02), which all had signiticant differences compared with that of HIBD group( P ＜ 0. 01). There was no significant difference of the brain weight between right and left side in NGF group but there was significance in HIBD group, which were[(3.39 ±0. 10) g and(0. 57 ±0.05) g] respectively(P ＜ 0.01) . The F-VEP latencies immediately after HIBD in both NGF group and HIBD group[(36.84±2. 120) ms, and(36.44±1.94)ms, respectively] were significantly prolonged compared with that[ (30. 27 ±1.52) ms ] of control group ( P ＜ 0. 01 ) and the amplitude of wave significantly decreased( P ＜ 0. 01) . The F-VEP latency of HIBD group after 7 days [(48.17±2.08) ms] was significantly prolonged compared with that [(29. 80 ± 1.93) ms] of control group at same time point as well as the decrease of amplitude of wave[ (2.75 ± 0.69) mV, and(4.22 ± 0. 87) mV respectively, P ＜ 0. 01 ] . The F-VEP latency of NGF group [ (32.08 ±1.85 ) ms ] significantly shortened and the amplitude of wave heightened [ (3.97 ± 0. 75) mV] compared with that[ (48. 17 ± 2.08) ms] and[ (2.75 ±0.69) mV] of HIBD group at same time point(P ＜0.01).CONCLUSION: The latency and amplitude of wave of the major wave in F-VEP can rapidly reflect cerebral functional status after HIBD. NGF treatment relieves the brain atrophy after HIBD and improves the cerebral function.