作者：王丽艳，倪文昌，边俊梅

单位：

430074湖北省武汉市第三医院儿科

Units：

Paediatrics Departemnt, Wuhan Third Hospital, Wuhan 430074, China

关键词：

缺氧缺血，脑；胞二磷胆碱；重组人促红素；Tau蛋白质类；神经元特异性烯醇化酶；治疗结果

Keywords：

Hypoxia-ischemia, brain; Citicoline; Recombinant human erythropoietin; Tau proteins; Neuron specific enolase; Treatment outcome

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2022.00.020

Funds：

摘要：

　背景　新生儿缺氧缺血性脑病（HIE）具有较高的病死率、致残率，临床主要采用胞二磷胆碱治疗新 生儿HIE并取得了一定疗效，但该药物不良反应较多，一定程度上影响了临床疗效，因此探寻新的治疗方式对提高新 生儿HIE的治疗效果具有重要的临床意义。目的　探讨胞二磷胆碱联合重组人促红素治疗新生儿HIE的临床疗效及其 对患儿神经功能的影响。方法　选取2019年1月至2021年1月武汉市第三医院新生儿科收治的120例HIE患儿为研究对 象，按照随机数字表法分为对照组和观察组，各60例。患儿均予以常规对症支持治疗，在此基础上，对照组患儿采用 胞二磷胆碱注射液治疗，观察组患儿在对照组基础上采用重组人促红素注射液治疗，两组患儿均持续治疗30 d。比较 两组患儿的临床疗效，原始反射、肌张力、意识状态恢复正常时间，治疗前及治疗后10、20、30 d新生儿行为神经评 定量表（NBNA）评分，治疗前、治疗后30 d血清Tau蛋白、神经元特异性烯醇化酶（NSE）水平，并观察两组患儿治 疗期间不良反应发生情况。结果　观察组患儿临床疗效优于对照组（P＜0.001）。观察组患儿原始反射、肌张力、意 识状态恢复正常时间短于对照组（P＜0.05）。时间与治疗方法在NBNA评分上存在交互作用（P＜0.05）；时间、治疗方 法在NBNA评分上主效应均显著（P＜0.05）。观察组患儿治疗后10、20、30 d NBNA评分高于对照组（P＜0.05）。两组 患儿治疗后10、20、30 d NBNA评分分别高于本组治疗前，治疗后20、30 d NBNA评分分别高于本组治疗后10 d，治疗 后30 d NBNA评分分别高于本组治疗后20 d（P＜0.05）。观察组患儿治疗后30 d血清Tau蛋白、NSE水平低于对照组（P ＜0.05）。两组患儿治疗后30 d血清Tau蛋白、NSE水平分别低于本组治疗前（P＜0.05）。两组患儿治疗期间均未发生 严重不良反应。结论　胞二磷胆碱联合重组人促红素治疗新生儿HIE的临床疗效确切，可有效改善患儿的神经功能， 减轻神经损伤，促进疾病快速恢复，且安全性较高。

Abstract：

　Background Neonatal hypoxic-ischemic encephalopathy (HIE) has a high mortality and disability rate, which is mainly treated by citicoline and has achieved certain curative effect, but there are many adverse reactions of citicoline, which affected the clinical efficacy to some extent. Therefore, it is of great clinical significance to explore new treatment methods to improve the therapeutic effect of neonatal HIE. Objective To investigate the clinical effect of citicoline combined with recombinant human erythropoietin in the treatment of neonatal HIE and the impact on neurological function of children. Methods A total of 120 HIE children were selected in Paediatrics Departemnt, Wuhan Third Hospital from January 2019 to January 2021, and they were divided into control group (n=60) and observation group (n=60) according to random number table method. All children were given routine symptomatic support treatment, on this basis, children in control group were treated with citicoline injection, children in observation group were treated with recombinant human erythropoietin injection based on control group, both groups were treated with 30 days. Clinical effect, original reflex, muscle tension and consciousness returned to normal time, Neonatal Behavioral Neurological Assessment Scale (NBNA) score before treatment and at 10, 20, 30 days after treatment, serum levels of Tau protein, neuron specific enolase (NSE) were compared between the two groups, incidence of adverse reactions were observed between the two groups. Results Clinical effect in observation group was better than that of control group (P < 0.05) . Original reflex, muscle tension and consciousness returned to normal time in observation group were shorter than those of control group (P < 0.05) . There was statistically significant interaction between time and treatment method on NBNA score (P < 0.05) ; main effects of time and treatment method were statistically significant on NBNA score (P < 0.05) . NBNA score at 10, 20, 30 days after treatment in observation group was higher than that of control group (P < 0.05) . In the two groups, NBNA score at 10, 20, 30 days after treatment was higher than that before treatment, respectively; NBNA score at 20, 30 days after treatment was higher than that at 10 days after treatment, repectively; NBNA score at 30 days after treatment was higher than that at 20 days after treatment (P < 0.05) . Serum levels of Tau protein, NSE at 30 days after treatment in observation group were lower than those of control group (P < 0.05) . Serum levels of Tau protein, NSE at 30 days after treatment in the two group were lower than those before treatment (P < 0.05) . No serious adverse reactions occurred in the two groups during treatment. Conclusion Citicoline combined with recombinant human erythropoietin have an exact clinical effect in the treatment of neonatal HIE, which can obviously improve neurological function of children, reduce neurological function injury, promote the rapid recovery of diseases, and with high safety

ReferenceList：