文章摘要

重组人促红素联合亚低温治疗新生儿缺氧缺血性脑病的疗效及对血清HMGB1、GFAP、ACTA水平的影响

作者: 1李文英, 1冶斐然, 1兰志兵
1 张家口市妇幼保健院新生儿科，河北 张家口 075000
通讯: 李文英 Email: hbzjkzms@163.com
DOI: 10.3978/j.issn.2095-6959.2022.06.016

摘要

目的：探讨重组人促红素(recombinant human erythropoietin，rHu-EPO)注射液联合亚低温治疗新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy，HIE)的疗效及对血清高迁移率族蛋白B1(high mobility group protein B1，HMGB1)、胶质纤维酸性蛋白(glial fibrillaryacidic protein，GFAP)、激活素A(activin A，ACTA)水平的影响。方法：将2018年1月至2020年10月张家口市妇幼保健院收治的96例HIE患儿随机分为两组，各48例。对照组采取常规对症治疗+亚低温治疗，观察组在对照组的基础上注射rHu-EPO，共治疗14 d。根据患儿意识及肌张力恢复情况评估两组临床疗效，并比较两组意识恢复时间、肌张力恢复时间、原始反射时间、呼吸恢复时间及惊厥停止时间；于治疗前后采用新生儿行为测定法(neonatal behavioral neurological assessment，NBNA)评估患儿神经功能发育状况，采用酶联免疫吸附法检测血清HMGB1、GFAP、ACTA表达水平；记录两组治疗期间的不良反应事件。结果：观察组总有效率为85.42%，显著高于对照组的62.50%(P<0.05)。观察组患儿意识、肌张力、原始反射、呼吸恢复时间及惊厥停止时间明显短于对照组(P<0.05)。观察组治疗后14 d的NBNA评分显著高于对照组(P<0.05)，血清HMGB1、GFAP、ACTA水平显著低于对照组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论：rHu-EPO注射液与亚低温联合治疗HIE的效果显著，可促进患儿神经功能恢复，降低血清HMGB1、GFAP、ACTA表达水平。
关键词： 新生儿缺氧缺血性脑病；亚低温疗法；重组人促红素；神经功能

Effect of recombinant human erythropoietin injection combined with mild hypothermia on neonatal hypoxic-ischemic encephalopathy and its effect on serum HMGB1, GFAP and ACTA levels

Authors: 1LI Wenying, 1YE Feiran, 1LAN Zhibing
1 Department of Neonatology, Zhangjiakou Maternal and Child Health Hospital, Zhangjiakou Hebei 075000, China

CorrespondingAuthor: LI Wenying Email: hbzjkzms@163.com

DOI: 10.3978/j.issn.2095-6959.2022.06.016

Abstract

Objective: To investigate the efficacy of recombinant human erythropoietin (rHu-EPO) injection combined with mild hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy (HIE) and its effect on the levels of serum high mobility group protein B1 (HMGB1), glial fibrillary acidic protein (GFAP) and activin A (ACTA). Methods: A total of 96 children with HIE treated in our hospital from January 2018 to October 2020 were randomly divided into two groups, 48 cases in each group. The control group was treated with routine symptomatic treatment + mild hypothermia, and the observation group was injected with rHu-EPO on the basis of the control group for 14 days. The clinical efficacy of the two groups was evaluated according to the recovery of consciousness and muscle tension, and the recovery time of consciousness, muscle tension, primitive reflex time, respiratory recovery time and convulsion stop time were compared between the two groups. The neonatal behavioral assessment (NBNA) was used to evaluate the neurological function of children before and after treatment. The expression levels of serum HMGB1, GFAP and ACTA were detected by enzyme-linked immunosorbent assay; at the same time, adverse events during treatment were recorded. Results: The total effective rate in the observation group was 85.42%, which was significantly higher than 62.50% in the control group (P<0.05). The consciousness, muscle tone, primitive reflex, respiratory recovery time and convulsion stop time in the observation group were significantly shorter than those in the control group (P<0.05). The scores of NBNA 14 days after treatment and MDI and PDI 6 months after treatment in the observation group were higher than those in the control group (P<0.05). After treatment, the NBNA score of the observation group was significantly higher than that of the control group 14 days after treatment (P<0.05), the levels of serum HMGB1, GFAP and ACTA in the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (22.92% vs 14.58%, P>0.05). Conclusion: Rhu EPO injection combined with mild hypothermia is effective in the treatment of HIE, which can promote the recovery of neurological function and intellectual development, and reduce the expression levels of serum HMGB1, GFAP and Acta.

Keywords： neonatal hypoxic ischemic encephalopathy; mild hypothermia therapy; recombinant human erythropoietin; nerve function

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