神经节苷脂对早产儿脑损伤神经行为影响的研究
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摘要
目的:探讨神经节苷脂(ganglioside,GM-1)对早产儿脑损伤的保护作用及预后的改善。方法:选择2015-01～2016-06在我院新生儿科住院治疗的脑损伤早产儿(28wk≤胎龄<37wk)共68例,分为GM-1治疗组(n=45),对照组(1,6-二磷酸果糖治疗,n=23),治疗组在常规治疗基础上加用GM-1 20mg/d,连用14d,据病情使用l～3疗程。所有患儿在纠正胎龄40wk、41wk时进行新生儿神经行为评分(neonatal behavioral neurological assessment,NBNA),生后3、6mo时进行头颅B超检查。结果:GM-1治疗组与对照组NBNA评分平均数在纠正胎龄40wk(35.37±1.98,34.00±2.33)、41wk(35.53±1.84,34.17±2.23)比较,治疗组均高于对照组,差异均有统计学意义(P<0.05)。两组纠正胎龄40wk、41wk在NBNA评分≥35分、<35分例数上比较,治疗组NBNA评分≥35分比率高于对照组,差异有统计学意义(P<0.05)。两组生后3、6个mo头颅B超检查结果差异均无统计学意义(P>0.05)。结论:GM-1对脑损伤早产儿神经行为发育有促进作用,可改善近期预后。
Objective:To study the protective effects and the improvement of prognosis of GM-1 on treating the premature infants with brain damage.Methods Sixty-eight premature infants(28 week≤ gestational age<37 week) with brain injury were selected, who were hospitalized in pediatric neonatal unit of our hospital from January 2015 to June 2016.They were divided into GM-1 treatment group(n=45) and control group(1,6-diphosphate treatment n=23).On the basis of positive treatment,the treatment group meanwhile accepted the treatment of GM-1 20 mg/d for 14 days. According to requirement of disease, they were carried for 1-3 periods. Neonatal behavioral neurological assessments for all infants were performed separately in 40 weeks and 41 weeks after correcting gestational age.Examinations of cranial ultrasound were done on 3 months and 6 months after birth. Results: The NBNA scores of GM-1 group both in the corrected gestational age of 40 weeks and 41 weeks were significantly higher than those of control group(P<0.05).The number of two groups' cases in the NBNA score ≥35 points and <35 were statistical significant difference at the corrected gestational age of 40 weeks and 41 weeks. Two groups' examinations of cranial ultrasound done on 3 months and 6 months after birth were no statistical significant difference(P>0.05).Conclusion: The GM-1 can rehabilitate the damaged neurological system of premature infants with brain damage.Early administration can promote development of the neurobehavioral and improve prognosis in the early life.
Objective:To study the protective effects and the improvement of prognosis of GM-1 on treating the premature infants with brain damage.Methods Sixty-eight premature infants(28 week≤ gestational age<37 week) with brain injury were selected, who were hospitalized in pediatric neonatal unit of our hospital from January 2015 to June 2016.They were divided into GM-1 treatment group(n=45) and control group(1,6-diphosphate treatment n=23).On the basis of positive treatment,the treatment group meanwhile accepted the treatment of GM-1 20 mg/d for 14 days. According to requirement of disease, they were carried for 1-3 periods. Neonatal behavioral neurological assessments for all infants were performed separately in 40 weeks and 41 weeks after correcting gestational age.Examinations of cranial ultrasound were done on 3 months and 6 months after birth. Results: The NBNA scores of GM-1 group both in the corrected gestational age of 40 weeks and 41 weeks were significantly higher than those of control group(P<0.05).The number of two groups' cases in the NBNA score ≥35 points and <35 were statistical significant difference at the corrected gestational age of 40 weeks and 41 weeks. Two groups' examinations of cranial ultrasound done on 3 months and 6 months after birth were no statistical significant difference(P>0.05).Conclusion: The GM-1 can rehabilitate the damaged neurological system of premature infants with brain damage.Early administration can promote development of the neurobehavioral and improve prognosis in the early life.
引文
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[8]任亚方,张焕新,张靖.rhEPO联合GM1治疗重度新生儿缺氧缺血性脑病的临床疗效观察.重庆医学,2018;47(6):824-827
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[10]Albertine KH.Brain injury in chronically ventilated preterm neonates:collateral damage related to ventilation strategy[J].Clin Perinatol,2012;39(3):727-740
[11]Manuel Hinojosa-Rodríguez,Thalía Harmony,Cristina Carrillo-Prado,et al.Clinical neuroimaging in the preterm infant:Diagnosis and prognosis.Neuroimage Clin.,2017;16(1):355–368
[12]Klebermass K,Olischar M,Waldhoer T,et al.Amplitude-integrated EEG pattern predicts further outcome in preterm infants.Pediatr Res,2011;70(1),102–108
[13]Song J,Xu F,Wang L,et al.Early amplitude-integrated electroencephalography predicts brain injury and neurological outcome in very preterm infants.Sci Rep,2015;5(10):13810.
[14]史鸽,王新华,苏振军.神经节苷脂对早产儿脑损伤神经行为的改善作用.中国实用医刊,2008;35(23):33-34.
[15]兰小红,祝大丽.神经元特异性烯醇化酶在新生儿疾病中的临床应用研究进展.中国医药,2018;13(7):1110-1113.
[16]陆俊秀,陈敬国,陈海燕等.脑白质病变早产儿神经节苷脂治疗前后血清IL-6、NSE和颅脑超声的变化及意义.广东医学,2012;33(16):2410-2411
[2]Manuel Hinojosa-Rodriguez,Thalia Harmony,Cristina Carrillo-Prado,et al.Clinical neuroimaging in the preterm infant:Diagnosis and prognosis.Neuroimage Clin,2017;16(1):355–368
[3]Vardit Rubovitch,Yael Zilberstein,Joab Chapman,et al.Restoring GM1 ganglioside expression ameliorates axonal outgrowth inhibition and cognitive impairments induced by blast traumatic brain injury.Sci Rep,2017;7(1):41269
[4]Kim H,Gano D,Ho ML,et al .Hindbrain regional growth in preterm newborns and its impairment in relation to brain injury.Hum Brain Mapp,2016;37(2):678-688
[5]Devasuda Anblagan,Rozalia Pataky,Margaret J,et al .Evans,Association between preterm brain injury and exposure to chorioamnionitis during fetal life.Sci Rep,2016;6(1):37932
[6]刘彩霞,景卫莉.早产儿脑损伤发病机制研究进展.医学综述,2015;21(9):1638-1640
[7]Raphael Martus Marcon,Alexandre Fogac a Cristante,Tarci sio Eloy Pessoa de Barros Filho,et al.Effects of ganglioside G(M1) and erythropoietin on spinal cord lesions in rats:functional and histological evaluations.Clinics (Sao Paulo) ,2016;71(6):351–360
[8]任亚方,张焕新,张靖.rhEPO联合GM1治疗重度新生儿缺氧缺血性脑病的临床疗效观察.重庆医学,2018;47(6):824-827
[9]Rong X,Zhou W,Xiao-Wen C,et al .Ganglioside GM1 reduces white matter damage in neonatal rats.Acta Neurobiol Exp (Wars),2013;73(3):379-386
[10]Albertine KH.Brain injury in chronically ventilated preterm neonates:collateral damage related to ventilation strategy[J].Clin Perinatol,2012;39(3):727-740
[11]Manuel Hinojosa-Rodríguez,Thalía Harmony,Cristina Carrillo-Prado,et al.Clinical neuroimaging in the preterm infant:Diagnosis and prognosis.Neuroimage Clin.,2017;16(1):355–368
[12]Klebermass K,Olischar M,Waldhoer T,et al.Amplitude-integrated EEG pattern predicts further outcome in preterm infants.Pediatr Res,2011;70(1),102–108
[13]Song J,Xu F,Wang L,et al.Early amplitude-integrated electroencephalography predicts brain injury and neurological outcome in very preterm infants.Sci Rep,2015;5(10):13810.
[14]史鸽,王新华,苏振军.神经节苷脂对早产儿脑损伤神经行为的改善作用.中国实用医刊,2008;35(23):33-34.
[15]兰小红,祝大丽.神经元特异性烯醇化酶在新生儿疾病中的临床应用研究进展.中国医药,2018;13(7):1110-1113.
[16]陆俊秀,陈敬国,陈海燕等.脑白质病变早产儿神经节苷脂治疗前后血清IL-6、NSE和颅脑超声的变化及意义.广东医学,2012;33(16):2410-2411