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目的 研究围生期窒息缺氧对脐血免疫功能的影响,探讨免疫学变化在新生儿缺氧缺血性脑病(HIE)发病中的意义,为HIE的免疫学治疗提供理论参考。方法 选取1999年5月～2000年6月3家医院出生、合并HIE的围生期窒息新生儿40例为研究对象,并取同期出生无窒息的40例正常新生儿为对照组。于婴儿出生断脐后即刻留取母体端脐动脉血3.5ml,分离血清并检测脐血T淋巴细胞亚群、血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、血浆一氧化氮(NO)、可溶性白细胞介素-2受体(SIL-2R)、红细胞C_(3b)受体花环率(E-C_(3b)RR)和红细胞免疫复合物花环率(E-ICR)等免疫指标的变化。结果 与正常新生儿比较,围生期窒息患儿脐血CD_3~+、CD_4~+减少[分别为(50±8)％比(58±10)％、(32±9)％比(40±10)％,均P<0.01],CD_8~+变化不大,CD_4~+/CD_8~+比值降低[(1.8±0.7)比(2.5±1.1),P<0.01];脐血IL-6与NO水平较低[分别为(71±19)pg/ml比(82±28)pg/ml、(59±24)μmol/L比(85±31)μmol/L,均P<0.05],IL-8与TNF-α则较高[分别为(0.56±0.23)ng/ml比(0.40±0.12)ng/ml、(1.03±0.30)ng/ml比(0.82±0.31)ng/ml,均P<0.01],且窒息程度越重上述改变越明显。窒息患儿脐血SIL-2R水平明显高于正常新生儿[(672±418)U/ml比(336
Objective To study the effect of perinatal asphyxia and hypoxia on immune function in cord blood and to explore the significance of immunological changes in the pathogenesis of neonatal hypoxic-ischemic encephalopathy (HIE), so as to provide a theoretical reference for the immunological treatment of HIE. Methods Forty infants with perinatal asphyxia born in HIE at three hospitals from May 1999 to June 2000 were selected as the study objects. Forty normal neonates without asphyxia during the same period were selected as the control group. The umbilical cord blood samples were collected from the umbilical cord immediately after the baby was born, and 3.5 ml of the umbilical artery blood samples were collected from the umbilical cord. Serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8) ), Tumor necrosis factor-α (TNF-α), plasma nitric oxide (NO), soluble interleukin-2 receptor (SIL-2R) and erythrocyte C_ (3b) ) RR and erythrocyte immune complex rosette rate (E-ICR) and other immune parameters. Results Compared with normal neonates, the percentage of CD_3 ~ + and CD_4 ~ + in umbilical cord blood of children with perinatal asphyxia were (50 ± 8)% (58 ± 10)%, (32 ± 9)% (1.8 ± 0.7) vs (2.5 ± 1.1), P <0.01]. The levels of IL-6 and IL-6 in cord blood were significantly lower than those in control group The levels of NO were lower (71 ± 19 pg / ml vs 82 ± 28 pg / ml, 59 ± 24 μmol / L vs 85 ± 31 μmol / L, respectively, P <0.05] -8 and TNF-α were significantly higher than those in control group [(0.56 ± 0.23) ng / ml vs (0.40 ± 0.12) ng / ml vs (1.03 ± 0.30) ng / ml vs <0.01], and the more the degree of suffocation the more obvious changes. SIL-2R levels in cord blood of children with asphyxia were significantly higher than those of normal neonates [(672 ± 418) U / ml vs 336