缺血缺氧性脑病新生儿免疫功能的变化及影响因素的分析

目的：观察和分析缺血缺氧性脑病（ HIE）新生儿免疫功能的变化及影响因素。方法选取60例HIE患儿作为观察组，选取60例健康新生儿作为对照组，对两组新生儿外周血中CD19^＋、CD19^＋ CD2^＋5 B淋巴细胞的百分率、IgG、IgM、IgA、补体C3、C4水平进行检测和分析，同时对新生儿的Apgar评分、胎盘情况、羊水污染情况、喂养方式、分娩方式等进行观察和对比。结果对照组新生儿的CD1＋9淋巴细胞比例、CD19^＋ CD2^＋5淋巴细胞比例、IgM、IgA、C3、C4水平均显著高于观察组（ t＝3．586、4．158、3．262、3．457、3．056、5．163，均P＜0.05）；重度HIE患儿的CD19^＋淋巴细胞比例、CD19^＋ CD2^＋5淋巴细胞比例、IgM、IgA、C3、C4水平均显著低于中度HIE患儿或轻度HIE患儿（t＝3．285、4．752、5．113、3．748、4．287、3．953、4．116、5．201、6．284、3．416、5．314、3.928、4．063、6．026，均P＜0．05），且中度HIE患儿的IgA和C4水平显著低于轻度患儿（t＝3．452、3．281，均P＜0．05）；新生儿的CD1＋9淋巴细胞比例、IgA水平、C4水平均与新生儿的Apgar评分呈正相关关系（r＝0．768、0．026、0．016，均P＜0．05），而且窒息的症状越严重，免疫指标的降低程度越大；新生儿的IgG、IgM水平与羊水污染程度呈负相关关系（r＝-0732、-0．025，均P＜0．05），IgA水平与母乳喂养呈正相关关系（r＝0．053， P＜0．05），IgG水平与出生体质量呈正相关关系（r＝0．018，P＜0．05）。结论 HIE患儿存在明显的免疫功能下降，且其免疫功能下降程度可能与病情存在相关性，患儿的出生状态、窒息情况、羊水污染情况、喂养方式、出生体质量都是其免疫功能指标的相关影响因素。

Analysis of the change and the influence factors of the immune function of the neonates with hypoxic ischemic encephalopathy

Objective To observe and analyze the change and the influence factors of the immune function of the neonates with hypoxic ischemic encephalopathy （ HIE） .Methods 60 patients with HIE were selected as the observation group,and 60 healthy neonates were selected as the control group.The CD1＋9 ,CD1＋9 CD2＋5 B lymphocyte per-centages,IgG,IgM,IgA,complement C3,C4 levels in peripheral blood of the neonates in the two groups were detected and analyzed.At the same time, the Apgar scores, placenta condition, amniotic fluid contamination degrees,the modes of delivery,modes of feeding of the neonates in the two groups were observed and compared.Results The percentages of CD1＋9 lymphocytes or CD1＋9 CD2＋5 lymphocytes,IgM,IgA,C3,C4 levels of the neonates in the control group were significantly higher than those of the observation group （ t=3.586,4.158,3.262,3.457,3.056,5.163, all P〈0.05）;the percentages of CD1＋9 lymphocytes or CD1＋9 CD2＋5 lymphocytes,IgM,IgA,C3,C4 levels of the severe HIE patients were significantly lower than those of the moderate HIE patients or the mild HIE patients （ t=3.285, 4.752,5.113,3.748,4.287,3.953,4.116,5.201,6.284,3.416,5.314,3.928,4.063,6.026,all P〈0.05） and the IgA and C4 levels of the moderate HIE patients were significantly lower than that of the mild HIE patients （ t=3.452,3.281,all P〈0.05）;the percentage of CD1＋9 ,IgA,C4 levels of the neonates with HIE were positively cor-related with Apgar score （ r=0.768,0.026,0.016,all P〈0.05） .When the choking symptoms were severer,the im-mune indexes decreased more significantly;the IgG,IgM levels of the neonates with HIE were negatively correlated with the amniotic fluid contamination degrees（r=-0732,-0.025,all P〈0.05）;the IgA level was positively corre-lated with breastfeeding（r=0.053,P〈0.05）,and the IgG level was positively correlated with the birth weight（r=0.018,P〈0.05）.Conclusion The immune function of neonates with HIE significantly decreases and the decline of the immune function ma