神经节苷脂治疗新生儿缺氧缺血性脑病的疗效及随访

doi:10.3877/cma.j.issn.1673-5250.2012.05.005

中华妇幼临床医学杂志(电子版) ›› 2012, Vol. 08 ›› Issue (05) : 578 -580. doi: 10.3877/cma.j.issn.1673-5250.2012.05.005

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论著

神经节苷脂治疗新生儿缺氧缺血性脑病的疗效及随访

赵浦¹, 赵雪妮¹^,^*^,^*(

), 梁洁竞¹, 张磊¹

^1. 150036　哈尔滨，黑龙江省医院儿科

收稿日期:2012-04-11 修回日期:2012-08-06 出版日期:2012-10-01
通信作者: 赵雪妮
基金资助:
黑龙江省卫生厅科研课题(2007－085)

Curative Effects of Monosialotetrahexosylganglioside on Neonatal Hypoxic-Ischemic Encephalopathy

Pu ZHAO¹, Xue-ni ZHAO¹(), Jie-jing LIANG¹, Lei ZHANG¹

^1. Department of Pediatrics, Heilongjiang Provincial Hospital, Haerbin 150036, Heilongjiang Province, China

Received:2012-04-11 Revised:2012-08-06 Published:2012-10-01
Corresponding author: Xue-ni ZHAO
About author:
(Corresponding author: ZHAO Xue-ni, Email: zhaopu1974@yahoo.cn)

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目的

评价单唾液酸四己糖神经节苷脂(GM1)对新生儿缺氧缺血性脑病(HIE)急性期恢复及远期神经行为发育的影响。

方法

选取2006年1月至2007年12月本院新生儿科收治的中度HIE患儿50例为研究对象。按照其治疗方式不同，将其分为治疗组(n＝27，接受GM1治疗)和对照组(n＝23，接受1，6－二磷酸果糖治疗) (本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会同意，分组征得患儿家属的知情同意，并于其签署临床研究知情同意书)。分别于生后3 d及13 d采用新生儿期神经行为测定(NBNA)评分法，并于随访第1，4，7个月时采用《Gesell发育量表》进行5个能区(大动作、精细动作、语言能、应物能和应人能)的发育评估。2组患儿在性别、胎龄、年龄、HIE分度、治疗时间等方面比较，差异无统计学意义(P>0.05)。

结果

两组分别于生后3 d和13 d进行NBNA测定结果显示，差异均无统计学意义(P>0.05)，《Gesell发育量表》评分显示，第1，4，7个月时，2组总平均值及语言能方面比较，差异有统计学意义(P<0.05)，而其他方面比较，差异无统计学意义(P>0.05)。

结论

新生儿期应用GM1治疗HIE可减少神经系统异常及发育障碍的发生。

关键词: 神经节苷脂, 缺氧缺血性脑病, 神经行为发育测定, 新生儿行为神经测定

Objective

To evaluate curative effects of monosialotetrahexosylganglioside on neonatal hypoxic-ischemic encephalopathy(HIE) and its long-term effect on nerve behavioral development of infants with HIE.

Methods

From January 2006 to December 2007, fifty neonates with moderate HIE were divided into two groups according to different treatment method: Treatment group (n=27, receiving GM1) and control group(n=23, receiving 1, 6 fructose diphosphate). Informed consent was obtained from all parents. The score of Neonatal Behavioral Neurological Assessment (NBNA) was evaluated in acute phase (3-day and 13-day after birth) of brain injury. All the patients were followed up every three month and Gesell Development Schedule was used to evaluate the neurodevelopment in convalescence phase. There had no significant different between two groups on age, gestational age, gender, HIE degrees and so on (P>0.05).

Results

There was no significant difference in NBNA score between two groups at 3 days and 13 days (P>0.05). There was significant difference in the Gesell Development Schedule of average socre and language development score between treatment group and control group (P<0.05).

Conclusions

Early use of GM1 has prolonged benefit to the patient with HIE.

Key words: monosialotetrahexosylganglioside, hypoxic-ischemic encephalopathy, Gesell development schedule, neonatal behavioral neurological assessment

表1 两组患儿NBNA评分比较(±s，分)

Table 1 Comparison of NBNA between two groups (±s, score)

组别	n	NBNA评分
组别	n	3 d	13 d
治疗组	27	34.8±3.5	38.5±4.3
对照组	23	35.2±1.6	38.1±2.6
t	?	0.678	0.301
P	?	>0.25	>0.25

表1 两组患儿NBNA评分比较(±s，分)

Table 1 Comparison of NBNA between two groups (±s, score)

组别	n	NBNA评分
组别	n	3 d	13 d
治疗组	27	34.8±3.5	38.5±4.3
对照组	23	35.2±1.6	38.1±2.6
t	?	0.678	0.301
P	?	>0.25	>0.25

表2 两组患儿1个月龄时《Gesell发育量表》评分比较(±s,分)

Table 2 Comparison of Gesell Developmental Schedules at one－month－old between two groups (±s, score)

组别	n	总平均值	大动作	精细动作	语言能	应物能	应人能
治疗组	27	99.7±4.7	98.7±6.0	100.0±8.7	100.7±6.1	98.9±9.9	100.1±8.1
对照组	23	97.7±3.1	97.5±8.5	98.4±8.5	97.4±6.3	97.0±10.0	98.2±7.0
t	?	1.716	0.616	0.639	1.900	0.654	0.871
P	?	<0.05	>0.25	>0.25	<0.05	>0.25	>0.10

表2 两组患儿1个月龄时《Gesell发育量表》评分比较(±s,分)

Table 2 Comparison of Gesell Developmental Schedules at one－month－old between two groups (±s, score)

组别	n	总平均值	大动作	精细动作	语言能	应物能	应人能
治疗组	27	99.7±4.7	98.7±6.0	100.0±8.7	100.7±6.1	98.9±9.9	100.1±8.1
对照组	23	97.7±3.1	97.5±8.5	98.4±8.5	97.4±6.3	97.0±10.0	98.2±7.0
t	?	1.716	0.616	0.639	1.900	0.654	0.871
P	?	<0.05	>0.25	>0.25	<0.05	>0.25	>0.10

表3 两组患儿4个月龄时《Gesell发育量表》评分比较(±s,分)

Table 3 Comparison of Gesell Developmental Schedules at four－month－old between two groups (±s, score)

组别	n	总平均值	大动作	精细动作	语言能	应物能	应人能
治疗组	27	99.5±4.5	99.3±10.1	98.5±9.0	101.9±7.6	98.7±10.7	99.2±9.0
对照组	23	94.6±8.7	95.3±14.5	94.6±7.8	94.6±10.2	93.2±16.0	95.3±7.3
t	?	2.589	1.147	1.640	2.887	1.454	1.656
P	?	<0.05	>0.10	>0.05	<0.05	>0.05	>0.05

表3 两组患儿4个月龄时《Gesell发育量表》评分比较(±s,分)

Table 3 Comparison of Gesell Developmental Schedules at four－month－old between two groups (±s, score)

组别	n	总平均值	大动作	精细动作	语言能	应物能	应人能
治疗组	27	99.5±4.5	99.3±10.1	98.5±9.0	101.9±7.6	98.7±10.7	99.2±9.0
对照组	23	94.6±8.7	95.3±14.5	94.6±7.8	94.6±10.2	93.2±16.0	95.3±7.3
t	?	2.589	1.147	1.640	2.887	1.454	1.656
P	?	<0.05	>0.10	>0.05	<0.05	>0.05	>0.05

表4 两组患儿7个月龄时《Gesell发育量表》评分比较(±s,分)

Table 4 Comparison of Gesell Developmental Schedules at seven－month－old between two groups (±s, score)

组别	n	总平均值	大动作	精细动作	语言能	应物能	应人能
治疗组	27	100.1±7.2	100.2±11.2	99.2±8.6	101.3±8.7	100.4±17.3	99.4±5.5
对照组	23	97.0±5.4	97.3±6.7	97.6±8.2	97.0±5.9	96.7±10.4	96.4±8.4
t	?	1.688	1.087	0.663	2.017	0.896	1.498
P	?	<0.05	>0.10	>0.25	<0.05	>0.10	>0.05

表4 两组患儿7个月龄时《Gesell发育量表》评分比较(±s,分)

Table 4 Comparison of Gesell Developmental Schedules at seven－month－old between two groups (±s, score)

组别	n	总平均值	大动作	精细动作	语言能	应物能	应人能
治疗组	27	100.1±7.2	100.2±11.2	99.2±8.6	101.3±8.7	100.4±17.3	99.4±5.5
对照组	23	97.0±5.4	97.3±6.7	97.6±8.2	97.0±5.9	96.7±10.4	96.4±8.4
t	?	1.688	1.087	0.663	2.017	0.896	1.498
P	?	<0.05	>0.10	>0.25	<0.05	>0.10	>0.05

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Curative Effects of Monosialotetrahexosylganglioside on Neonatal Hypoxic-Ischemic Encephalopathy

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Curative Effects of Monosialotetrahexosylganglioside on Neonatal Hypoxic-Ischemic Encephalopathy