rhu-EPO辅助治疗对新生儿缺氧缺血性脑病氧化应激损伤及Caspase-3、ACT A水平的影响

摘要

Objective To investigate the effects of rhu-EPO on hypoxic-ischemic etieephalopath(HIE) oxidative stress injury and Caspase-3,endogenous activin A (ACT A).Methods One hundred and thirty patients with HIE were randomly assigned to group A(rhuEPO adjuvant therapy) and group B(conventional therapy),65 patients in each group.And 65cases of healthy newborns were choosen into the group C in order to compare the treatment effect,adverse fate of difference and the differences of superoxide dismutase (SOD),malondialdehyde(MDA),Caspase-3,ACT A and neonatal behavioral neurological assessment (NBNA) observed on the day of treatment,1 week of treatment and 4 weeks of treatment between group A and B.Results Group A efficiency(92.3％) was higher than group B(70.7％),the difference was statistically significant(P＜0.05);The levels of SOD,MDA,Caspase-3 and ACT A in group C were not significantly changed in the different time points,while the levels of SOD in group A and group B were significantly higher,there was significant difference in the inter-group,inter-point,and inter-group/hour-time interactions among the three groups(P＜0.05).The levels of ACT A in group A and B were increased gradually,there was significant difference in the inter-group,inter-point,and inter-group/hour-time interactions between the three groups(P＜0.05).The levels of Caspase-3 in group A and B were increased first and then decreased,there was significant difference in the inter-group,inter-point,and inter-group/hourtime interactions between the three groups(P＜0.05).The level of MDA in group A and B were decreased gradually,in the inter-group,inter-point,and inter-group/hour-time interactions between the three groups(P＜0.05).The NBNA scores of group A and B were gradually increased,there was significant difference in the inter-group,inter-point,and inter-group/hourtime interactions between the three groups(P＜0.05).The incidence of adverse reactions in A group(7.7 ％0) were lower than the B group (30.8 ％),the difference was statistically significant.Conclusion Capspase-3 and ACT A are involved in the pathophysiological process of HIE,and rhu-EPO is used to treat HIE,which is beneficial to reduce the oxidative stress injury and levels of Caspase-3 and ACT A.%目的 探讨重组人促红细胞生成素(recombinant human erythropoietin,rhu-EPO)辅助治疗对新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopath,HIE)氧化应激损伤及半胱氨酸天冬氨酸蛋白酶3(cysteine aspartic protease-3,Caspase-3)、内源性激活素A(endogenous activin A,ACT A)的影响.方法 将130例HIE患者随机分为A组(rhu-EPO辅助常规治疗)与B组(常规治疗)各65例,并选择65例同期健康新生儿纳入C组,比较A组与B组在治疗效果、不良反应率差异及3组在治疗当天、治疗1周、治疗4周时超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)、Caspase-3、ACT A、新生儿神经行为测定(neonatal behavioral neurological assessment,NBNA)的差异.结果 A组疗效(92.3％)高于B组(70.7％),差异有统计学意义(P＜0.05).不同时间点C组SOD、MDA、Caspase-3、ACT A水平无显著变化,而A、B组SOD水平显著增高,3组在组间、时点间以及组间·时点间交互作用差异均有统计学意义(P＜0.05);A、B组ACT A水平逐渐增高,且B组高于A、C组,3组在组间、时点间以及组间·时点间交互作用差异均有统计学意义(P＜0.05);A、B组Caspase-3呈先升高后降低的趋势,3组在组间、时点间以及组间·时点间交互作用差异均有统计学意义(P＜0.05);A、B组MDA水平逐渐下降,3组在组间、时点间以及组间·时点间交互作用差异均有统计学意义(P＜0.05);A、B组NBNA评分逐渐升高;3组在组间、时点间以及组间·时点间交互作用差异均有统计学意义(P＜0.05).A组不良反应发生率(7.7％)低于B组(30.8％),差异有统计学意义(P＜0.05).结论 Capspase-3及ACT A均参与HIE病理生理过程,且通过rhu-EPO辅助治疗HIE,有利于降低该病氧化应激损伤及Caspase-3、ACT A水平.