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目的 探讨缺氧缺血性脑病(HIE)患儿血清和脑脊液(CSF)中促红细胞生成素(Epo)的变化,观察Epo与脑损伤的关系。方法 对26例HIE患儿(轻度8例,中度10例,重度8例)和8例正常对照组进行研究,在生后0~24h、48~72h及7~10d抽取静脉血,HIE组在生后48~72h腰穿取CSF,放射免疫法测定血清和CSFEpo含量,HIE组生后7 ~10d做头部MRI检查。结果 对照组血清Epo随日龄增加呈下降趋势,有统计学差异(P<0. 05);HIE各组血清Epo水平呈先上升而后下降趋势,其中仅轻度组血清Epo变化显著(P<0. 05);各时间段重度组较轻度组、对照组血清Epo明显升高,有统计学差异。重度HIE组较轻、中度组CSFEpo明显升高(F=6.86,P<0. 01)。重度HIE组48~72hr血清与CSFEpo水平有较强直线相关关系(r= 0.76, P< 0. 05);而轻、中度HIE组血清与CSFEpo无直线相关关系(r= 0.12, r= 0.09, P> 0. 05)。头部MRI为重度改变的HIE患儿CSF中Epo水平均较头部MRI为轻、中度改变的HIE患儿显著升高(F= 8.56, P< 0. 01)。结论 HIE患儿血清Epo显著升高,持续不降是病情危重的标志。CSF中Epo显著升高提示HIE患儿脑损伤严重,预后不良。重度HIE患儿可能存在着血脑屏障的破坏,Epo可能透过血脑屏障。
Objective To investigate the changes of erythropoietin (Epo) in serum and cerebrospinal fluid (CSF) of children with hypoxic-ischemic encephalopathy (HIE) and to observe the relationship between Epo and brain injury. Methods Twenty-six HIE children (8 mild, 10 moderate, 8 severe) and 8 normal controls were enrolled in this study. Venous blood was collected at 0-24 h, 48-72 h and 7-10 d after birth. HIE At 48 ~ 72h after birth, the rats in group received CSF lumbar puncture and radioimmunoassay to determine the content of serum and CSFEpo. MRI was performed at 7-10 days after birth in HIE group. Results Serum Epo in control group showed a decreasing trend with the increase of age, with statistical significance (P <0.05). Serum Epo levels increased first and then decreased in HIE groups, with only a slight change in serum Epo (P < 0.05). Serum Epo of the severe group in each time period was significantly higher than that in the mild group, with statistical difference. Moderate HIE group was lighter, moderate group of CSFEpo was significantly higher (F = 6.86, P <0.01). There was a strong linear correlation between serum levels of CSFEpo and serum levels of 48-72 hr in severe HIE group (r = 0.76, P <0.05), while there was no linear correlation between serum and CSFEpo in mild HIE group (r = 0.12, r = 0.09 , P> 0.05). Epo levels in CSF of HIE children with severe head MRI were significantly lower than those with head MRI and moderately changed HIE (F = 8.56, P <0.01). Conclusions Serum Epo in children with HIE is significantly increased and continues to decline is a sign of critical illness. Epo was significantly increased CSF CSF HIE brain injury in children with severe, poor prognosis. Severe HIE children may have the destruction of the blood-brain barrier, Epo may cross the blood-brain barrier.