朱敏　苏彩云　陈巧玲

[摘要] 目的 研究重組人促红细胞生成素（EPO）联合神经节苷脂治疗新生儿缺氧缺血性脑病（HIE）的效果。 方法 选取2016年1月～2017年6月于淮北矿工总医院就诊的HIE的患儿80例，根据治疗方法将其分为对照组（40例）和研究组（40例）。对照组患儿采用单唾液酸四己糖神经节苷脂（GM-1）进行治疗，研究组采用GM-1与重组人EPO的联合用药治疗，治疗持续10～14 d。采用新生儿神经行为表（NBNA）评价两组患儿出生后7、14、28 d的神经行为；采用智能发育评估量表（CDCC）和中枢神经系统评价量表（Gesell）分别对两组患儿3月龄和6月龄时的智能发育和发育商进行评价，并评价两组的治疗效果和预后。 结果 两组患儿在出生后7 d时，NBNA评分差异无统计学意义（P > 0.05），研究组患儿在出生后14 d和28 d时，NBNA评分均显著高于对照组（P < 0.05）；两组患儿6月龄的智力发育指数（MDI）、心理运动发育指数（PDI）评分及Gesell评分均显著高于3月龄（P < 0.05），研究组3月龄及6月龄患儿MDI、PDI评分及Gesell评分均显著高于对照组（P < 0.05）；研究组患儿的总有效率为92.50%，显著高于对照组的75.00%（P < 0.05），且两组后遗症及预后差异无统计学意义（P > 0.05）。 结论 重组人EPO与GM-1联合用药可以明显改善HIE患儿的神经行为和中枢神经系统功能，具有良好的临床疗效，安全性较高，具有较高的临床应用价值。

[关键词] 重组人促红细胞生成素；神经节苷脂；新生儿缺氧缺血性脑病；疗效

[中图分类号] R742 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0066-05

[Abstract] Objective To study the clinical effect of recombinant human erythropoietin （EPO） combined with gangliosides on neonatal hypoxic-ischemic encephalopathy （HIE）. Methods A total of 80 cases of children with HIE were selected and divided into the control group （40 cases） and the study group （40 cases） in Huaibei Miner General Hospital from January 2016 to June 2017 according to the treatment. The control group was treated with Monosialoteterahexosyl ganglioside （GM-1）. the study group was treated with GM-1 and recombinant human EPO， and the treatment lasted for 10-14 day. The NBNA scale was used to evaluate the neurobehavior on the 7th， 14th， and 28th day after birth. The CDCC and Gesell scales were used to evaluate the intellectual development and developmental quotients of the two groups at 3 months and 6 months of age， respectively， and the therapeutic efficacy and prognosis of the two groups were evaluated. Results There was no significant difference in NBNA scores between the two groups 7 d after birth （P > 0.05）. The NBNA scores of the study group were significantly higher on the 14th and 28th day after birth than in the control group （P < 0.05）. MDI， PDI scores and Gesell scores at 6 months of age in both groups were significantly higher than those at 3 months of age （P < 0.05）. The MDI， PDI scores and Gesell scores of the study group at 3 months and 6 months of age were significantly higher than those of the control group （P < 0.05）. The total effective rate in the study group was 92.50%， which was significantly higher than the 75.00% in the control group （P < 0.05）. There was no significant difference in sequelae and prognosis between the two groups （P > 0.05）. Conclusion The combination therapy of GM-1 and recombinant human EPO can significantly improve the neurobehavioral and central nervous system function in children with HIE. The treatment method has good clinical efficacy， high safety， and has great clinical application value.

[Key words] Recombinant human erythropoietin； Ganglioside； Neonatal hypoxic ischemic encephalopathy； Treatment effect

新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy，HIE）是由各种原因引起的脑组织缺血缺氧导致的新生儿脑部病变[1]。患儿症状表现为神经系统损害，这是造成新生儿以及胎儿急性死亡的重要原因之一。HIE多采用单唾液酸四己糖神经节苷脂（monosialoteterahexosyl ganglioside，GM-1）进行治疗。GM-1多存在于动物的细胞膜中，广泛分布于中枢神经系统[2]，其对脊髓损伤和神经退变具有一定的治疗作用[3]，但GM-1对HIE临床治疗效果不稳定。因……