THE CHANGES OF VASCULAR ACTIVATING FACTORS IN
NEONATAL HYPOXEMIC-ISCHEMIC ENCEPHALOPATHY AND ITS INFLUENCE ON CEREBRAL
HEMODYNAMICS
Liu J, Guo XX, Cao HY
Beijing Yanhua Hospital, Beijing, China
Objective: To study the variation of
endothelin-1 (ET-1), calcitonin gene-related peptide (cGRP),C-type
natriuretic peptide (CNP), neuropeptide Y (NPY), neurotensin (NT)，nitric oxide (NO)，interleukin-6 (IL-6),
Interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α) and its clinical implication,
and to analyze the influence of vascular activating factors on cerebral
arteries hemodynamics in neonates with hypoxemic-ischemic encephalopathy
(HIE).
Methods: The authors
prospectively observed the variation of ET-1, cGRP, CNP，NPY，NT， NO，IL-6，IL-8 and TNF-α in cord blood and peripheral blood at the time of 1 day, 3 days and
7 days after birth in HIE and healthy controls by using radioimmuneassay
and two point-assay of nitrate reducatse,respectively. The cerebral
arteries hemodynamics were determined immediately using the color Doppler
ultrasonography at 1 day after had obtained blood samples.
Results: (1) The cord blood and 1
day after birth peripheral blood vascular activating factors in neonatal
HIE and healthy controls was respectively: ET-1 (70.4±25.2 ) ng/L vs (38.1±18.9) ng/L (p<0.01)
and (57.4±14.0) ng/L vs (34.7±9.1) ng/L
(p<0.01).cGRP (286±142) ng/L vs (187±86) ng/L (p<0.01) and
(322±154) ng/L vs (196±104) ng/L (p<0.01). CNP (292±111) ng/L vs (147±68) ng/L (p<0.01) and
(311±122) ng/L vs (123±35) ng/L (p<0.01).NPY (615±311）ng/L vs （199±63）ng/L (p<0.01) and (356±157 ) ng/L vs (214±57) ng/L (p<0.01). NT
(234±136 ) ng/L vs (68±20) ng/L (p<0.01) and (200±66) ng/L vs (43±19) ng/L (p<0.01). NO
(61.3±24.4 ) μmol/L vs (99.7±34.1) μmol/L (p<0.01) and
(72.7±27.7) μmol/L vs (93.1±29.1) μmol/L (p<0.01). IL-6
(70.5±18.8) vs (81.8±27.9) ng/L (p<0.01) and (52.6±24.5) vs (80.2±29.4)
ng/L (p<0.01). IL-8 (0.34±0.09) vs 0.26±0.07μg/L (p<0.01) and
(0.47±0.13) vs (0.68±0.16) μg/L (p<0.01). TNF-α(1.03±0.30) vs (0.82±0.31) μg/L (p<0.01) and
(1.18±0.31) vs (0.91±0.30) μg/L (p<0.01). These
showed serum ET-1, cGRP, CNP, NPY , NT ,IL-8 (in cord blood) and TNF-α were significantly
elevated and IL-6 ,IL-8 (in peripheral blood) were decreased in neonates with
HIE. The serum levels of CNP, NPY and IL-6 would return to normality at the
third day, while ET-1 and TNF-α at the end of the first
week after birth. However, NT，cGRP and IL-8 were still
to abnormality during the first week. It also showed the serum levels of NO
was decreased in neonates with HIE, but it was increasing gradually, and at
the third day it would reach to healthy controls' levels, and it would
elevated higher than normal neonates' levels at 7 days after birth. (2) The
Dopple ultrasonography showed the cerebral arteries blood velocity was
decreased while cerebral blood resistance was increased. (3) Linear
regression has showed the resistance index (RI) negatively correlated with
IL-6 (r=-0.61,p<0.01), and positively correlated with IL-8 and TNF-α(r=0.80, 0.72,
respectively, p<0.01), while multiple regression has showed that ET-1,
cGRP and CNP have a significant influence on cerebral arteries hemodynamics
in neonates with HIE.
Conclusion: The imbalance of ET-1,
cGRP and CNP in asphyxiated neonates was the main reasons of cerebral
hemodynamic disturbance (CHD) in neonatal HIE, and cytokines have a
significant influence on CHD.