The Value Of Plasma 8-iso-prostaglandin F 2alpha In Evaluating The Condition And NAC Therapeutic Effect For HIE Neonates

Objective: Our researches have three aims. The first one is to test the level of plasma 8-iso-prostaglandin F2a (8-iso-PGF2a) of the normal neonates in one week after their births; The second one is to explore the correlation between the change in the level of plasma 8-iso-PGF2a of the neonates suffered from hypoxic-ischemic encephalopathy (HIE) and the condition of neonates with HIE; The third one is to investigate the mechanism and therapeutic efficacy of Nacetylcysteine (NAC) in the assistance of treating neonates with HIE.Methods: 83 neonates suffered from HIE were recruited. They were randomly dividedinto two groups: NAC group (n=40) and conventional therapy group (n=43). Underlaying conventional therapy, the NAC of 20~30 mg/kg.d were taken by the neonates in the NAC group within 24 hours after their births, and this treatment process continued 7 days. Furthermore, 24 cases of normal neonates were chosen as a contrast group. We respectively collected the blood samples from HIE neonates and normal neonates on the first, third, seventh day after their births, and then tested the plasma 8-iso-PGF2a contents by EIA assay. In addition, we made NBNA scores from the second day to the third day and from the seventh day to the ninth day, and observed the change of clinical neuro-symptoms of moderate and serious HIE neonates.Results: CD The plasma level of the 8-iso-PGF2a of the normal neonates in one weekafter their births was 13.39±6.25pg/ml(95% confidence interval for mean was 11.78 -17.56pg/ml); If the upper-bound 17.56pg/ml of 95% confidence interval were taken as a standard of distinguishing the normal and abnormal, the specificity and sensitivity of 8-iso-PGF2a were 95% and 97.6%, respectively, (g) The plasma level of 8-iso-PGF2a of normal neonates reach at its peak within 24 hours after their births, while the plasma level of 8-iso-PGF2a of the neonates with the light and moderate HIE dropped down to that of normal neonates on the third day after their births, the plasma level of 8-iso-PGF2a of the neonates with serious HIE still higher than that of normal neonates on the seventh day after their births.For the neonates with light, moderate, serious HIE, significant differences in their plasma 8-iso-PGF2a level occurred on the first day vs. the third day and the first day vs. the seventh day after their births, but no significant difference in the plasma 8-iso-PGF2a level was observed on the third day vs. the seventh day. (3) 2~3 days later after the serious HIE neonates in the NAC group were treated by the NAC, the NBNA scores were higher than the conventional therapy group and the continue times of the hyperspasmia became shorter, while the plasma 8-iso-PGF2a level dropped down. For the light HIE neonates who were treated by NAC for 7~9 days and the moderate HIE neonates who were treated by NAC for 2~3 days, their NBNA scores were significantly improvement.Conclusion: Both the damages of oxygen free radicals and the lipid peroxidation playvery important role in the generation and development of HIE. The early stage of Hypoxio-ischemic brain damage(HIBD) may be the optimal opportunity of the antioxidant therapy. The dynamic observation of the plasma 8-iso-PGF2a level can assess the condition and prognosis of neonates with HIE. The combination of the synthetic therapy with the NAC can improve the condition and prognosis of neonates with HIE and is worthy to be generalized in clinic treatment.