窒息新生儿干预前后血清细胞因子的变化及对缺氧缺血性脑病发病的影响

目的 探讨窒息新生儿干预前后血清白细胞介素6(IL-6)、白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)对新生儿缺氧缺血性脑病(HIE)发病的临床意义.方法 选择我院出生的正常新生儿40名(健康对照组)、窒息新生儿70例(窒息组),将窒息组随机分为两组,常规治疗组30例,维持良好的通气与换气功能,维持心率、血压在正常范围,维持血糖在正常高值,控制惊厥,降低颅内压,消除脑干症状等；1,6-二磷酸果糖组(FDP组)40例,在常规治疗基础上于出生6h内静脉注射FDP注射剂250mg/(kg·d),疗程10 d.健康对照组无特殊处理,已出院者于出生10 d返院回访.监测3组新生儿出生6h、3d、10 d血清IL-6、IL-8、TNF-α浓度,观察窒息新生儿72 h内HIE的发生率.结果 窒息组出生6h内IL-6、IL-8、TNF-α与健康对照组比较差异均无统计学意义(P均＞0.05),出生3 d IL-6低于健康对照组(2.22±1.26)、(3.04±0.98) ng/L,P＜0.05],IL-8、TNF-α高于健康对照组(18.62±14.56)、( 15.65±11.25) ng/L,(50.28±18.74)、(42.02±12.25) ng/L,P均＜0.05].出生3 d FDP组IL-6高于常规治疗组(2.65±1.13)、( 1.24±1.06) ng/L,P＜0.05],IL-8、TNF-α明显低于常规治疗组(17.24±12.48)、(22.46±10.88) ng/L,(44.62±18.27)、( 54.25±17.28) ng/L,P均＜0.01]；3组间IL-6于出生10 d时差异均无统计学意义(P均＞0.05),而FDP组IL-8、TNF-α明显低于常规治疗组(14.25±12.75)、(17.23±11.33) ng/L,(37.41 ±17.55)、(48.21±16.54) ng/L,P均＜0.01]；FDP组HIE的发生率22.5％ (9/40)]及中、重度HIE的发生率5.0％(2/40)]明显低于常规治疗组46.7％ (14/30)与26.7％ (8/30)],差异均有统计学意义(x2=4.53,P＜0.05;x2=4.59,P＜0.05).结论 围产期窒息患儿外周血IL-6降低,IL-8、TNF-α升高,其可能参与HIE的发病过程.早期干预能降低HIE的发生率及中、重度HIE的发生率.

Changes of serum cytokines and the impact of hypoxic.ischemic encephalopathy before and after the intervention of neonates with asphyxia

Objective To explore serum interleukin-6 （ IL-6 ）, interleukin-8 （ IL-8 ）, tumor necrosis factor α （TNF-et） on neonatal hypoxic ischemic eneephalopathy （HIE） in the pathogenesis of clinical significance before and after the intervention of neonates with asphyxia. Methods forty cases of normal neonates were selected as normal group,70 cases of neonates with asphyxia were selected as asphyxia group and they were randomly divided into Fructose-1,6-diphosphate （FDP）group （conventional treatment combined with FDP, n = 40）and control group （conventional treatment, n = 30）. Patients in the conventional treatment group were maintained good ventilation function, their heart rate, blood pressure were in normal range, and their blood sugar were in normal high-value. And measures were taken to control convulsions, increase intracranial pressure and eliminate the brainstem symptoms. Patients in the Fructose-1,6-diphosphate （FDP） group were treated with intravenous FDP injection 250 mg/（ kg ~ d） within 6h after birth in addition to the conventional treatment, and the course was 10 days. No special treatment was given to the healthy control group, and they returned to hospital for a return visit after discharged form hospital at the birth of the lOth day. The level of IL-8, IL-6 and TNF-o~ were monitored in three groups after they were born 6 h, 3 d and 10 d, and 72 h HIE incidence rate were observed. Results There was no significant difference on the level of IL-6, IL-8 and TNF-c~ within 6 h after birth in asphyxia group （ P 〉 0. 05 ）. Within 3 days after birth, IL-6 level was lower than that in the normal group （2. 22 ~ 1.26） ng/L vs （ 3.04 ＋ 0. 98 ） ng/L, P 〈 0. 05 1, IL-8, TNF-c~ levels were higher than those in the normal group （ 18.62 ~ 14. 56） ng/L vs （ 15.62 ~ 11.25 ） ng/L, （50. 28 ~- 18.74） ng/L vs （42.02 _＋ 12. 25 ） ng/L,P 〈 0. 05 ]. In FDP group, within 3 days after birth, the level of IL-6 was higher than that in control group （2. 65 ~ 1.13） ng/L vs （1.24 ＋ 1.06） ng/L,P 〈0. 05] ,the levels of IL-8 and TNF-ot were significantly lower than those in the control group （ 17. 24 ＋ 12.48） ng/L vs （22. 46 ＋ 10. 88） ng/L, （44. 62 ＋ 18.27） ng/L vs （54. 25 ＋ 17.28）ng/L,P 〈0. 01 ] ;There was no significant difference on the level of IL-6 on the 10th day after birth among the three groups （ P 〉 0. 05 ） . While in the FDP group, the levels of IL-8 and TNF-ctwere significantly lower than those in the control group （ 14. 25 ＋ 12.75 ） ng/L vs （ 17.23 ＋ 11.33 ） ng/L, （37.41 ~ 17.55 ）ng/L vs （48.21 -＋ 16. 54 ）ng/L, P 〈 0. 01 ] ;The incidence of HIE and moderate to severe HIE in FDP group were significantly lower than that in the control group （22. 5% （9/40）vs 46. 7% （14/30）, X2 = 4. 538, P 〈 0. 05 ;5 % （2/40） vs 26. 7% （ 8/30 ）, X2 = 4. 595, P 〈 O. 05 ]. Conehtsion Blood level of IL-6 was lower and the level of IL-8 and TNF-ot were higher in perinatal asphyxia and HIE patients, they may be involved in the pathogenesis of HIE. Early intervention can reduce the incidence of HIE and the incidence of severe HIE.