摘要
目的 研究新生儿缺氧缺血性脑病 (HIE)患儿的免疫学变化及其机制 ,为免疫学治疗提供理论依据。 方法 以 4 0例正常新生儿及 4 0例 HIE患儿为对象 ,分别检测脐血、生后 1、3、7、12～ 14 d及 2 6～ 2 8d外周血 T淋巴细胞亚群、血清可溶性白细胞介素 2受体、白细胞介素 (IL ) 6、8以及肿瘤坏死因子α、血浆一氧化氮、免疫球蛋白、补体、红细胞 C3b受体花环率、红细胞免疫复合物花环率等免疫指标的变化 ,并于新生儿生后 2 4 h内取静脉血后即刻应用脉冲多普勒超声检测其大脑中动脉的血流动力学参数。 结果 窒息缺氧与 HIE患儿存在 :(1) T淋巴细胞亚群紊乱 ,如生后 1～ 3dHIE与对照组分别为 CD3+ (6 2± 8) %、(6 5± 10 ) % ,CD4 + (39± 7) %、(46± 8) % ,CD8+ (2 3± 6 ) %、(19± 5 ) % ,CD4 + / CD8+比值 1.8± 0 .7、2 .5± 0 .7。至生后 2 6～ 2 8d时上述各指标间差异均无显著性。(2 ) Ig M与 C3降低。(3)细胞因子表达异常。(4)血流动力学参数 RI与 IL- 6呈负相关 (r=- 0 .0 1,P<0 .0 1) ,与 IL- 8及 TNF- α呈正相关 (r=0 .80、0 .72 ,P<0 .0 1)。 结论 免疫功能紊乱参与了 HIE的发病过程 ,细胞因子对脑血流的异常影响可能是免疫因素导致脑损伤的原因之一。
Objective To explore the immunologic changes and its immunologic mechanism in neonatal hypoxic ischemic encephalopathy(HIE).Methods T lymphocyte subpopulation, serum interleukin 2 receptor (SIL 2R), interleukin 6(IL 6), interleukin 8 (IL 8), tumor necrosis factor alpha (TNF α), nitric oxide (NO), immunioglobin(Ig), complement (C 3), the percentage of RBC C 3b receptor rosette(E C 3b RR), RBC immune complex rosette ( E ICR) and cerebral artery hemodynamics was tested in newborns with HIE and normal controls. The umbilical blood samples and peripheral blood samples were obtained at the time of 1 day, 3 days, 7 days, 12～14 days and 26～28 days after birth. Results Birth asphyxia and HIE were associated with under regulated immune function, which include:(1) T Cell population disorder. In HIE and control group, CD 3 +were(62±8)%vs(65±10)%,CD 4 +(39±7)% vs (46±8)%,CD 8 +(33±6)% vs (19±5)%,CD 4 +/CD 8 + ratio (1.8±0.7) vs (2.5±0.7) on 1 to 3 days after birth. There were no signficant difference in both group on 26 to 28 days after bith ). (2)The IgM and C 3 were decreased.(3)The cytokins were abnormal. (4) RI was negetively correlated with IL 6 ( r=-0.61,P< 0.01 ), and positively correlated with IL 8 and TNF α ( r=0.80?0 72,respectively,P< 0.01 ). Conclusion (1)HIE was associated with immune function disorder, and the immune aberration may inturn involve in the mechanism of secondary brain demage.(2) The cytokin can influence the changes of hemodynamics, which may be one of the reasons of immune factors resulting in brain reperfusion injury.
出处
《中华围产医学杂志》
CAS
2002年第2期113-117,共5页
Chinese Journal of Perinatal Medicine
