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目的:采用串联质谱法技术,进行窒息新生儿血肉碱谱与脑损伤相关性的研究,并观察不同程度的窒息新生儿血肉碱谱的变化规律。方法:研究对象为胎龄≥37周,体重≥2.5 kg的窒息新生儿组,对照组为正常的足月产新生儿。每组各选取50例入组。检测研究组所有娩出后新生儿的脐血,生后1周,生后1个月的外周血,检测血肉碱谱。并于上述相同的时间内收集记录患儿的临床信息及实验室、影像学检查结果等,分为窒息后发生脑损伤组与非脑损伤组。结果:①窒息新生儿组的血游离肉碱及总肉碱水平均低于正常新生儿对照组(P<0.05)。②窒息后发生脑损伤的新生儿在生后1周内血游离肉碱及总肉碱水平均明显低于非脑损伤组(P<0.01),而长链酰基肉碱在生后1周内较非脑损伤组明显升高(P<0.05)。③重度窒息的新生儿在生后1周内游离肉碱、短链、中链酰基肉碱水平较轻度窒息组低,长链酰基肉碱水平则高于轻度窒息组,差异有统计学意义(P<0.05),生后1个月两者比较差异无统计学意义(P>0.05)。结论:窒息新生儿的血肉碱谱变化与脑损伤的发生存在关联,血肉碱谱的变化可以协助早期判断及评估新生儿窒息后脑损伤的发生及预后。
OBJECTIVE: To study the correlation between carnitine and brain injury in neonates with asphyxia by tandem mass spectrometry, and observe the changes of carnitine spectrum in newborns with different degree of asphyxia. Methods: The subjects were asphyxiated neonates with gestational age ≥37 weeks and body weight ≥2.5 kg. The control group was normal full-term neonates. Each group selected 50 cases into the group. All the umbilical blood of the newborns in the study group were tested for peripheral blood 1 week after birth and 1 month after birth, and the carnosine spectrum was detected. At the same time, we collected and recorded the clinical information, laboratory findings and imaging findings of the children. The patients were divided into groups of brain injury and non-brain injury after asphyxia. Results ① The levels of free carnitine and total carnitine in neonates with asphyxia were lower than those in normal neonates (P <0.05). (2) The free carnitine and total carnitine levels in neonates with post-asphyxial brain injury were significantly lower than those in non-brain injury group (P <0.01), while the long-chain acylcarnitine within 1 week after birth Compared with non-brain injury group was significantly higher (P <0.05). ③ Severe asphyxia newborns within 1 week after birth free carnitine, short chain, medium-chain acylcarnitine levels were lower than mild asphyxia group, long-chain acylcarnitine levels were higher than mild asphyxia group, the difference was statistically significant (P <0.05). There was no significant difference between the two groups at 1 month after birth (P> 0.05). CONCLUSION: The changes of carnitine and alkaloid in neonates with asphyxia are related to the occurrence of brain injury. The change of carnitine may help to judge and evaluate the occurrence and prognosis of brain injury after neonatal asphyxia.