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目的:探讨窒息后新生儿HIE血清细胞因子的动态变化及其与HIE病情轻重和预后的关系。方法:31例窒息后HIE患儿分为轻、中、重度HIE组,以同期收治的窒息后无HIE新生儿34例及无窒息病史新生儿65例做为对照组,分别于HIE急性期(生后1～3d)和恢复期(生后4～7d)测定患儿血清中IL-1、IL-6、IL-8、TNF-a的水平,比较各组间的差异。同时对HIE组分别于生后3、7、14天接受NBNA评估,于3、7、12个月龄进行随访,评估智力发育指数(MDI)及心理运动发育指数(PDI)。结果:HIE组较对照组(窒息后无HIE组及正常组)血清细胞因子明显升高(P<0.05),特别是急性期患儿,升高更为明显(P<0.01),恢复期有所降低。HIE重度组细胞因子较轻、中度组明显升高(P<0.05)。HIE组NBNA评分,重度组较轻、中度组明显降低(P<0.05),评分越低,急性期细胞因子的水平越高(P<0.05),远期的智力发育指数(MDI)及心理运动发育指数(PDI)也反映了这一点。结论:某些细胞因子的变化可以反应HIE病情的严重程度,因此可以作为病情及预后早期评估的重要指标。
Objective: To investigate the dynamic changes of serum cytokines in neonates with neonatal asphyxia and its relationship with the severity and prognosis of HIE. Methods: Thirty-one neonates with hypoxic-ischemic encephalopathy (HIE) were enrolled in this study. Thirty-one HIE neonates with asphyxia were divided into mild, moderate and severe HIE group. Thirty-four neonates with asphyxia and 65 neonates without asphyxia were included in the study. The levels of IL-1, IL-6, IL-8 and TNF-a in the serum of the children were measured 1 ~ 3 days after birth and 4 ~ 7 days after convalescence. At the same time, NBNA was evaluated on the 3, 7, and 14 days after birth in HIE group and at 3, 7 and 12 months of age respectively to evaluate the mental development index (MDI) and psychomotor development index (PDI). Results: The levels of serum cytokines in HIE group were significantly higher than those in control group (no HIE group and normal group after asphyxia) (P <0.05), especially in acute stage (P <0.01) Reduced. HIE severe group cytokines lighter, moderate group was significantly higher (P <0.05). The score of NBNA in HIE group was lighter, the moderate group was lower (P <0.05), the lower the score was, the higher the level of cytokines was in acute stage (P <0.05), the long-term mental development index (MDI) Sports Development Index (PDI) also reflects this. Conclusion: The changes of some cytokines can reflect the severity of HIE, so it can be used as an important index for early assessment of disease and prognosis.