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目的检测缺氧缺血性脑病(hypoxic ischemicen cephalopathy,HIE)新生儿血清中谷氨酸(glutamate,Glu)水平的动态变化,探讨Glu水平和新生儿缺氧缺血性后脑损伤程度之间的关系。方法应用高效液相色谱法测定30例HIE患儿发病后1天、3天、7天血清Glu浓度,并与健康对照组比较。结果HIE患儿发病后1天、3天、7天血清Glu水平为(78.32±15.49)μmol/ml、(95.33±19.72)μmol/ml、(72.36±12.23)μmol/ml,病后1、3d均高于正常对照组水平(69.26±9.54)μmol/ml,差异显著,有统计学意义(P<0.05),以发病后第3天水平最高,此后呈降低趋势。重度HIE患儿发病后第3天血清Glu水平高于中、轻度组(P<0.05)。阿氏评分值与HIE发病后第3天血清Glu水平呈直线负相关(r=-0.732,P=0.009<0.05)。结论HIE患儿发病早期血清Glu水平即升高,且病情越严重,血清Glu升高越明显,提示血清Glu水平是判断缺氧缺血性后脑损伤病情严重程度及预后的客观指标。
Objective To investigate the dynamic changes of serum glutamate (Glu) levels in neonates with hypoxic ischemic encephalopathy (HIE) and to explore the relationship between the level of Glu and the degree of neonatal hypoxic-ischemic brain injury. Methods Serum Glu levels in 30 HIE children at 1 day, 3 days and 7 days after onset were determined by high performance liquid chromatography (HPLC) and compared with healthy controls. Results The serum Glu levels at 1, 3 and 7 days after onset of HIE were (78.32 ± 15.49) μmol / ml, (95.33 ± 19.72) μmol / ml and (72.36 ± 12.23) μmol / (69.26 ± 9.54) μmol / ml respectively. There was significant difference between the two groups (P <0.05) and the highest level on the third day after the onset of disease. The level of serum Glu in the third day after onset of severe HIE was higher than that in moderate and mild groups (P <0.05). There was a linear negative correlation between the scores of Aspergillus and serum Glu level on the third day after onset of HIE (r = -0.732, P = 0.009 <0.05). Conclusion The serum Glu level rises early in the onset of HIE and the more severe the disease, the more obvious increase of serum Glu, suggesting that serum Glu level is an objective index to judge the severity and prognosis of hypoxic-ischemic brain injury.