The protective effect of phosphate sodium on hypoxic-ischemic encephalopathy oxidative stress and myocardial injury in newborns
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摘要: 目的 探讨磷酸肌酸钠治疗新生儿缺氧缺血性脑病(HIE)心肌损伤的疗效及可能作用机制。 方法 选择HIE合并心肌损伤患儿共92例,按数字表法将所有患儿随机分为对照组46例和治疗组46例;所有患儿均给予低流量吸氧等对症支持治疗;对照组给予单唾液酸四己糖神经节苷酯钠液静脉滴注,20 mg/次,1次/d;治疗组在对照组基础上加用注射用磷酸肌酸钠,0.5~1.0 g加入5%葡萄糖10 ml中微泵,1次/d;2组均给予2周治疗。比较2组患儿血清肌酸激酶(CK),肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB);免疫印迹法检测2组血清烟酰胺腺嘌呤二核苷酸磷酸氧化酶2(NOX2)表达,检测2组患儿血清活性氧(ROS)、一氧化氮(NO)、核因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)和白细胞介素(IL)-6含量。 结果 治疗组患儿治疗后血清CK、cTnI和CK-MB水平均明显低于对照组(P<0.01);治疗组患儿治疗后LVEF和E/A均明显高于对照组(P<0.01);治疗后,治疗组患儿血清中NOX2、ROS、NO、NF-κB、TNF-α和IL-6含量均明显低于对照组,比较差异有统计学意义(P<0.01)。 结论 磷酸肌酸钠治疗新生儿HIE可有效降低心肌损伤标志物,改善心功能,抑制NOX2/ROS氧化应激通路从而减缓下游炎症损伤是其可能机制之一。Abstract: Objective To discuss clinical efficacy of creatine phosphate sodium in treating neonatal hypoxic ischemic encephalopathy(HIE) with myocardial damage and probable mechanism. Method Ninety-two HIE patients with myocardial damage in our hospital were randomly divided into control group (46 cases) and treated group(46 cases) with reference to digital table method.All patients were treated with supportive treatment including low flow oxygen therapy and so on.Patients of control group were given single sialic acid four hexose ganglion glucoside ester sodium intravenous drip(20 mg/time,qd).Patients of treatment group were given creatine phosphate sodium based on treatment of control group(0.5-1.0 g/time,qd).Courses for two groups were 2 weeks.Serum creatine kinase(CK),cardiac troponinI(cTnI) and creatine kinase-MB(CK-MB) in two groups were compared.Expression of serum nicotinamide adenine dinucleotide phosphate oxidase 2(NOX2)in two groups were detected by immunoblotting.Serum levels of reactive oxygen species(ROS),nitric oxide(NO),nuclear factor-κB(NF-κB),tumor necrosis factor-α(TNF-α) and interleukin(IL)-6 were detected in two groups. Results Serum levels of CK,cTnI and CK-MB after treatment were obviously lower in treatment group than those of control group(P<0.01).LVEF and E/A after treatment in treatment group were evidently higher than those of control one(P<0.01).After treatment,serum NOX2,ROS,NO,NF-κB,TNF-α and IL-6 in treatment group were obviously lower thanthose of control one with statistically significant difference(P<0.01). Conclusion Creatine phosphate sodium could reduce the myocardial injury markers effectively,improve heart function in treating HIE.One of the probable mechanisms may be related to restraining NOX2/ROS oxidative stress pathways and mitigating downstream inflammatory lesions.
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