新生儿缺氧缺血性脑病钙平衡紊乱与脑损伤的相关性研究(1)
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【摘要】 目的 检测新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)患儿红细胞内外钙浓度及红细胞膜上Ca2+-Mg2+-ATPase活性,研究所检测指标与脑损伤程度之间的关系,并探讨出现低钙血症时能否钙剂治疗,从而最大限度地提高HIE的疗效,减少死亡和伤残。方法 采用流式细胞仪测定86例不同程度新生儿缺氧缺血性脑病患者红细胞内Ca2+浓度,以I-STAT1-Analyzer测定血浆游离钙,以化学比色法测定红细胞膜Ca2+-Mg2+-ATPase活性;以30例足月新生儿作为对照组,均为羊水吸入和咽下综合征患者。将HIE组中部分患儿再分为补充钙剂组与未补充钙剂组,当补充钙剂疗程结束后再次检测各组相关指标。结果 HIE急性期血浆游离钙浓度水平均明显低于对照组,(P<0.05),红细胞内Ca2+浓度水平均明显高于对照组(P<0.05),红细胞膜上Ca2+-Mg2+-ATPase活性明显低于对照组(P<0.05);这些指标的变化与脑损伤的严重程度相关;在补充钙剂后红细胞膜上Ca2+-Mg2+-ATPase活性及红细胞内Ca2+浓度均与未补充钙剂组差异无统计学意义(P>0.05),而血浆游离钙浓度较未补钙组显著升高(P<0.05)。结论 HIE时红细胞内钙超载,血浆游离钙降低,且红细胞膜上Ca2+-Mg2+-ATPase活性降低;补充钙剂后红细胞内游离钙浓度并未明显上升,故而HIE时对有低钙血症临床表现的患儿补充钙剂是可行的,但本研究并未解决补充钙剂后是否会延长细胞内钙超载的持续时间,因此提出以短期应用为妥,一旦临床表现缓解即可停止补充,血浆游离钙仅做为参考。
【关键词】新生儿;缺氧缺血性脑病;红细胞内外钙浓度;红细胞膜Ca2+-Mg2+-ATPase活性
【Abstract】 Objective To research the relationship between some detective indicators and the neonatal hypoxic-ischemic encephalopathy(HIE)brain injury,by detecting the Ca2+concentrations inside and outside of erythrocytes as well as Ca2+-Mg2+-ATPase activity on erythrocyte membranes in children with HIE.Meanwhile,to discuss whether the calcium treatment could be used in the situation of hypocalcemia for the purpose of improving the effect of HIE maximatily and decreasing mortality and disability.Methods The clinical of 86 cases with HIE neonatus were studited. 86 cases of HIE neonatus,we detected erythrocyte intracellular Ca2+concentration by flow cytometry,plasma free calcium by I-STAT1-Analyzer and erythrocyte membranes Ca2+-Mg2+-ATPase activity by chemical assay.As the control group,30 cases of full term infants were takenwho were all inhaled and ingested amniotic fluid.The HIE group was subdivided into groups with and without calcium supplement.The above indicators were detected again in groups at the end of calcium treatment.
Results In HIE acute phase,plasma free Ca2+concentrations were significantly lower than the control group(P<0 ......
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