缺氧缺血性脑病患儿红细胞胞浆游离钙水平变化的临床意义

目的 探讨红细胞胞浆游离钙(RBCCa2+]i)在缺氧缺血性脑病(HIE)发病机制中的作用及其应用价值.方法 选择2002年6月至2006年3月我科收治的28例中、重度HIE患儿作为研究对象,HIE患儿入院后在常规治疗的基础上给予尼莫地平治疗,疗程7～10 d.于治疗前、治疗72 h和7～10 d各采集静脉血1次,采用Fura-2/AM法检测RBCCa2+]i水平.以我院产科同期收住的20例正常新生儿作为对照组.结果 (1)中、重度HIE组治疗前后各时间点RBCCa2+]i水平均明显高于对照组,差异具有显著性(P＜0.05,P＜0.01),中、重度HIE组间差异元显著性(P＞0.05).(2)HIE息儿RBCCa2+]i水平于治疗后72h达到高峰,然后逐渐恢复,至治疗7～10 d仍高于对照组(P＜0.05).(3)RBCCa2+]i水平与HIE程度存在明显正相关(r=0.447,P＜0.05).结论 RBCCa2+]i参与了HIE的病理生理过程,在HIE发病机制中可能起重要作用,动态监测RBCCa2+]i水平可能有助于HIE的早期诊断和预后判断.

Clinical significance of changes of RBC [Ca2 +]i levels in the neonates with hypoxic-ischemic encephalopathy

Objective To explore the role of RBCCa2+]i levels in pathogenesis of hypoxic-ischemic encephalopathy (HIE) in neonates. Methods Twenty-eight neonates with moderate and severe HIE hospitalizeal from Jun. 2002 to Mar. 2006 were enrolled the study. The neonates with HIE were given routine treatment and Nimodipine for 7～10 days. Blood samples were collected before treatment and at 72 hours,7～10 days after treatment respectively. The levels of RBC Ca2+]i were measured by Fura-2/AM. Twenty healthy full-term neonates were studied as controls. Results (1) The levels of RBC Ca2+] i in the neonates with moderate and severe HIE were significantly higher than that in control group at every time points( P＜0. 05 ,P＜0.01). (2) the levels of RBCCa2+]i in the neonates with moderate and severe HIE peaked at 72 hours after treatment,and were still significantly higher than that of control group at 7～10 days after treatment(P＜0. 05). (3) In the neonates with HIE,RBCCa2+ ]i levels correlated positively with the severity of HIE ( r = 0. 447, P＜ 0. 05 ). Conclusion RBC Ca2+ ] i levels are closely associated with pathogenesis of HIE, and may play an important role in the pathogenesis of HIE. Evaluating RBC Ca2+] i levels in neonate after birth may provide clinical clues for the early diagnosis and prognosis assessment of HIE.