目的 探讨新生儿缺氧缺血性脑病(HIE)T淋巴细胞亚群、D-二聚体及心肌酶水平的变化及意义.方法 选取2008年1月-2011年6月我院新生儿科足月HIE患儿65例为研究对象,分为轻度组24例、中度组21例、重度组20例,另随机选择同期、健康、足月新生儿30例作为对照组.检测所有受检新生儿T淋巴细胞亚群(CD3+、CD4+、CD8+) 的百分率,血浆D-二聚体、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平,并进行相关性分析.结果 4组外周血CD3+、CD4+、CD8+百分率、CD4+/CD8+、D-二聚体、α-HBDH、CK、CK-MB水平比较,差异均有统计学意义(P＜0.05).其中对照组与轻度组、中度组、重度组外周血CD3+、CD4+、CD8+百分率、CD4+/CD8+、D-二聚体、α-HBDH、CK、CK-MB水平比较,差异均有统计学意义(P＜0.05);轻度组与中度组、中度组与重度组、轻度组与重度组CD3+百分率、D-二聚体、α-HBDH、CK、CK-MB水平比较,差异均有统计学意义(P＜0.05);轻度组与中度组、重度组CD4+、CD8+百分率比较,差异均有统计学意义(P＜0.05);轻度组、中度组与重度组CD4+/CD8+比较,差异均有统计学意义(P＜0.05).Spearman相关分析,HIE患儿外周血CD4+/CD8+与D-二聚体呈负相关(r=-0.46,P＜0.05);CD4+/CD8+与CK-MB呈负相关(r=-0.89,P＜0.05);D-二聚体与CK-MB呈正相关(r=0.43,P＜0.05).结论 新生儿HIE的发生、发展是多因素参与的复杂过程,其中免疫、炎症反应、血管内皮细胞损伤、凝血/纤溶系统等异常可能是同步发生,并相互关联.%Objective To investigate the levels and correlation of serum T lymphocyte, D - dimer and myocardial enzymes in neonates with hypoxic - ischemic encephalopathy ( HIE ) . Methods 65 full - term neonates with HIE admitted to neonates department of our hospital from January 2008 to June 2011 were divided into mild group ( 24 cases ), moderate group ( 21 cases ) and severe group ( 20 cases ) . Meanwhile, 30 full - term healthy neonates of the same period were selected as control group. Serum T lymphocyte subsets percentage ( CD3 + , CD4 + , CD8 + ), plasma D - dimer, a - HBDH, CK and CK - MB were detected and the correlation was analyzed. Results The CD3 + , CD4 + and CD8 + levels in peripheral blood, CD4 + /CD8 + , D - dimer, a - HBDH, CK and CK - MB among the four groups all showed statistically significant differences ( P <0. 05 ) . The levels of CD3 + , CD4 + and CD8 + , CD4 VCD8 + , D - dimer, a - HBDH, CK and CK - MB in the control group showed statistically significant differences compared with those in the mild group, moderate group and severe group ( P < 0. 05 ) . The CD3 + , D - dimer, a - HBDH, CK and CK - MB all showed statistically significant differences between mild group and moderate group, moderate group and severe group and mild group and severe group ( P < 0. 05 ) . The levels of CD4 + and CD8 + in mild group showed statistically significant differences compared with those in the moderate group and severe group ( P < 0. 05 ) . The CD4 + / CD8 + in mild group and moderate group showed statistically significant difference compared with that in severe group ( P <0. 05 ). Spearman correlation analysis showed that the CD4 + /CD8 + in peripheral blood was negatively correlated with D - dimer in HIE neonates ( r = - 0. 46, P < 0. 05 ) . The CD4 + /CD8 + was negatively correlated with CK - MB ( r = - 0. 89, P < 0. 05 ) .The D - dimer was positively correlated with CK - MB ( r = 0. 43 , P < 0. 05 ) . Conclusion The occurrence and development of HIE in neonates is a complicated course involving various factors. Immune, inflammatory reaction, vascular endothelial cell injury and coagulation/fibrinolytic system abnormality may occur simultaneously and relate to each other.
展开▼
