缺氧缺血性脑病新生儿血浆内皮素和一氧化氮变化的临床研究

目的：观察血浆内皮素（ET）和一氧化氮（NO）在新生儿缺氧缺血性脑病（HIE）中的含量变化。阐明其在脑损伤中的作用及其与脑损伤程序的关系。方法：将40例HIE患儿分为轻，中，重3组，分别采用酶免法和比色法测定其急性期，恢复期血浆ET和NO含量，设15例正常新生儿为对照组，测定结果经统计学处理。结果：急性期中，重度组ET含量明显于对照组，重度组明显高于中度组，轻度组与对照组无明显差异，恢复期轻，中度组降至正常水平，而重度组仍保持较高水平，与对照组比较有显著性差异，急性期患儿血浆NO含量变化规律与ET相似，而恢复期轻，中，重度组均降至正常，与对照组比较无显著性差异，结论：HIE新生儿血浆ET和NO含量水平升高，且与脑损伤的程度呈正相关，如ET水平持续不降，提示脑损伤程度较重，预后差，如能早期阻断ET和NO所致神经毒性作用，有可能减轻HIE患儿神经细胞损伤程度。

THE CHANGES OF PLASMA ENDOTHELIN AND NITRIC OXIDE IN NEONATES WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY

Objective:To observe the changes of plasma concentrion of endothelin(ET) and nitric oxide(NO) in neonatal hypoxic ischemic encephalopathy(HIE) and to demonstrate their effects on brain lesion and the relationships with severity of brain lesion.Methods:40 newborns with HIE were divided into 3 groups according to their severity,the mild group,the moderate group and the severe group.15 normal newborns were chosen randomly as the control group.The plasma concentrations of ET and NO were tested by enzyme immunoassay and color matching analysis in acute and convalescent stages of HIE.Results:In the acute stage,the plasma concentration of ET increased in the moderate and severe groups compared with that in the control group,and was higher in the severe group than in the moderate one,but no significant difference was found between the mild and control groups.In the convalescent stage,the plasma concentration of ET was normal in the mild and moderate groups,and was still higher in the severe group,but no significant difference was found among the four groups.The change of plasma NO concentration had a similar pattern to ET in the acute stage,but the plasma NO concentration was normal in all the three groups in the convalescent stage and no significant differences were found compared with the control group.Conclusion:The plasma concentration of ET and NO increased in the newborns with hypoxic ischemic encephalopathy and had a positive relation with the severity of brain lesion.If the increased plasma concentration of ET lasts for a long time,it is suggested that there may be a severely damaged brain and a poor prognosis.