早期大剂量rhu-EPO对早产心神经发育的保护作用

目的探讨早期大剂量重组人促红细胞生成素(rhu-EPO)对早产儿神经发育的保护作用。方法选取符合条件的早产儿共42例,随机分为2组,治疗组和对照组各21例。两组患儿生后院内均予常规治疗及出院后早期干预治疗。治疗组于生后1、2、3天分别经静脉给予EPO1000U/kg。比较两组早产儿①生后3天内头颅B超及以后每周至少一次至出院时头颅B超异常发生率;纠正胎龄40周时、3个月、6个月头颅CT或MRI异常率;②在纠正胎龄40周时的新生儿神经行为测定(NBNA);纠正胎龄6个月、12个月Gesell发育量表评分;③纠正胎龄40周、6个月、12个月脑干听觉诱发电位(ABR)异常率。结果①EPO治疗组头颅B超、头颅CT或MR异常率低于对照组,两组间有显著性差异;②NBNA及Gesell发育量表评分治疗组优于对照组,差异有显著性;③ABR于纠正胎龄40周时两组间无显著差异,纠正胎龄6、12个月时治疗组异常率均较对照组低,且有显著性差异。结论早期大剂量使用EPO可显著改善早产极低出生体重儿儿预后,促进其神经系统发育。

Effect of Early High-Dose Recombinant Human Erythropoietin Therapy on Neurological Development in Preterm Very Low Birth Weight Infants

Objective To explore the effect of the early high-dose recombinant human erythropoietin(rhu-EPO) on neurological development in preterm very low birth weight infants.Methods 42 preterm very low birth weight infants were randomly divided into two groups:both treatment group and control group contained 21cases.Both groups were given the routine treatment of preterm infant.The treatment group received intravenous rhu-EPO(1000 IU/kg/d) from postnatal day 1、2、3.All infants were followed up until 12 months of corrected gestational age.The following examines were perform:①Brain ultrasound scan performed at the first 3day and at least once per week from postnatal day.Head CT or MRI performed at 6 and 12 months of corrected gestational age.②The score of Neonatal Behavioral Neurological Assessment(NBNA) at 40 weeks of corrected gestational age and the score of Gesell Development Schedule at 6 and 12 months of corrected gestational age.③Auditory brainstem response(ABR) were performed at 40weeks and 6 months and 12 months of corrected gestational age.Results ① The treatment group count a lower abnormal rate(70.8%) than the control group(79.7%,P <0.05) in brain ultrasound scan.the abnormal rate of head CT or MRI are few difference at early phase,but the treatment group count a lower abnormal rate at 6 and 12 months of corrected gestational age(25.00% vs.44.44%,P<0.05 and 27.00% vs.48.89%,P <0.05).②The scores of treatment group in NBNA and Gesell Development Schedule are higher than the control group(P<0.05).③On ABR,the abnormal rate are few difference at 40weeks of corrected gestational age,but the treatment group count a lower abnormal rate at 6 and 12months of corrected gestational age(P <0.05).Conculusion Early use of the high-dose EPO can promote neurodevelopment and remarkable improve the prognosis of the preterm infant.