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目的 研究新生儿缺氧缺血性脑病 (HIE)时血浆内皮素 1(ET- 1)、降钙素基因相关肽(c GRP)的变化及其对脑血流动力学的影响。 方法 用放射免疫法检测了 4 0例 HIE患儿和 4 0例正常新生儿脐血及生后 1、3、7d外周血 ET- 1与 c GRP的动态变化 ,并于生后 2 4 h取内外周静脉血后即刻应用脉冲多谱勒超声检测 HIE患儿大脑中动脉的血流动力学参数。 结果 (1) HIE患儿脐血与生后第 1天血浆 ET- 1水平分别为 (70± 2 5 ) ng/ L、(5 7± 14 ) ng/ L ,对照组分别为 (38± 19)ng/ L、和 (35± 99) ng/ L (P值均 <0 .0 0 1) ;c GRP水平分别为 (2 86± 14 3) ng/ L、(2 91± 15 4 ) ng/ L ,对照组分别为 (186± 87) ng/ L、(196± 10 4 ) ng/ L (P值均 <0 .0 0 1) ;至生后 1周末时 ET- 1可恢复正常 ,而 c GRP仍显著高于对照组。 (2 )多谱勒超声显示 HIE患儿脑血流阻力增加、血流速度减慢。 (3)直线相关回归分析表明 ,HIE脑血流阻力指数 (RI)与 ET- 1呈正相关 (r=0 .72 4 ,P<0 .0 1) ,与 c GRP呈负相关 (r=- 0 .719,P<0 .0 1)。 结论 新生儿窒息后 ET- 1、c GRP参与了 HIE的病理生理过程 ,其平衡失调可能是 HIE脑血流动力学紊乱的原因之一。窒息新生儿早期使用 c GRP或 c GRP活性样药物 ,对防止或减轻缺氧缺血性?
Objective To study the changes of plasma endothelin-1 (ET-1) and calcitonin gene-related peptide (cGRP) in neonates with hypoxic-ischemic encephalopathy (HIE) and its effect on cerebral hemodynamics. Methods The dynamic changes of ET-1 and c-GRP levels in cord blood of 40 HIE and 40 normal newborn infants and 1, 3 and 7 days after birth were detected by radioimmunoassay and taken at 24 h after birth Immediate application of pulsed Doppler sonography to detect hemodynamic parameters of middle cerebral artery in children with HIE. Results (1) The levels of plasma ET-1 in cord blood of HIE children and those on the first day after birth were (70 ± 2.5) ng / L and (57 ± 14) ng / L respectively, while those in the control group were (2 86 ± 14 3) ng / L, (2 91 ± 15 4) ng / L, and (35 ± 99) ng / L, respectively / L in the control group and (186 ± 87) ng / L and (196 ± 10 4) ng / L in the control group respectively (P <0.01); ET- While c GRP still significantly higher than the control group. (2) Doppler ultrasound showed increased cerebral blood flow resistance and slowed blood flow in children with HIE. (3) Linear regression analysis showed that the cerebral blood flow resistance index (RI) of HIE was positively correlated with ET - 1 (r = 0.72 4, P <0.01) and negatively correlated with c GRP 0 .719, P <0. 01). Conclusions ET-1 and c-GRP are involved in the pathophysiological process of HIE after neonatal asphyxia. The imbalance of ET-1 and c-GRP may be one of the causes of HIE cerebral hemodynamics disorder. Asphyxia neonatal early use of c GRP or c GRP activity-like drugs, to prevent or reduce hypoxic-ischemic?