| [Background]With development of technologies in maternity and neonatal intensive care, younger infant survival rate has been greatly improved, and accordingly increased preterm infants suffer white matter injury (WMI), which is a common type of brain injury in preterm infants, and could turn into Periventricular leucumalacia (PVL) for the worse.WMI is closely connected to the gestational age of the infants. The younger the infant is and the less weight the infant is, the higher the WMI rate is. Since brain blood vessels of younger infant is immature, for the one at the age of26～32weeks, the microvessel density and size of germinal matrix area are much higher and bigger than those of white matter area. The blood vessels of the germinal matrix area are mostly endothelial monolayer without support from elastic fibers in smooth muscle, so its ability of resisting blood flow impact is quite weak, and the blood vessels could be easily broken. The germinal matrix area will become smaller when the infant grows up and then disappears at the age of36weeks.PVL most often occurring in preterm infants is related with cerebral ischemia, which is basically caused by brain blood vessel structure immaturity and cerebral autoregulation dysfunction.The younger the infant’s gestational age is, especially before28weeks, the more likely he will have WMI. Due to immature brain blood vessels, younger infant has fewer joints of long blood vessels and short blood vessels in the brain since his branches of long brain blood vessels grow incompletely and short brain blood vessels are less, so least blood flow is distributed around peri ventricular area. Once the body’s blood pressure becomes lower, the periventricular area will most likely suffer cerebral ischemia, then results in a WMI disease.The short to wear branches of cerebral arteries supply blood to subcortical white matter, and the long to wear branches of cerebral arteries supply blood to periventricular deep white matter. The immature infants’periventricular arteries have less short to wear branches and no collateral circulation, and his cerebral arteries under cortex has not yet fully developed, so blood supply to white matter area is insufficient, which exacerbates PVL in the preterm infants due to cerebral ischemia. The veins are fanned out around periventricular white matter, and pass by the perivenricluar area and germinal matrix area before joining into terminal vein. When the venous pressure increases, water in white matter area can’t reflow, and will easily cause venous congestion and hemorrhagic infarction. Especially for the preterm infants under mechanical ventilation condition, increased venous pressure can bring obvious injury to brain reflux regulation, cause blood pressure lower, brain blood flow smaller, and then lead to blood supply insufficiency inside the vessel ends and surrounding areas for white matter, which will finally develop WMI in preterm infants. In32weeks after birth, blood vessels will gradually mature, and the rate of WMI is accordingly decreased.Therefore, PVL of preterm infants is closely related with maturity of blood vessels in perivenricluar area. The younger the infants’gestational age are and the less mature blood vessels in perivenricluar area are, the more likely PVL preterm infants will suffer.There are3types of Oligodendrocytes in preterm infants:Oligodendrocytes of the glial cell precursors, immature oligodendrocytes in glial cells and maturity less oligodendrocyte. The last one is the main element of myelin of brain white matter. The brain white matter in preterm infants, especially before32weeks after birth, mainly consists of active Oligodendrocytes of the glial cell precursors, which is the key target cell in PVL of the preterm infants. Oligodendrocytes of the glial cell precursors could easily cause ischemia,hypoxia and infection,thus to injury the brain structure.The injury of Oligodendrocytes of the glial cell precursors will result the injury of myelin of brain white matter. Furthermore, without myelin, brain white matter will reduce, and ventricle will increase, which is the key factor to cause PVL in preterm infants. It is founded that the brain injury caused by ischemia and hypoxia could decrease GM-1level in perinatal period, and GM-1decrease degree is connected to brain injury degree.The common pathological changes happen in white matter around delta parts and occipital angle of lateral ventricle, and anterior angle and body of lateral ventricle.There is no clarified treatment method for WMI in China and overseas. Prognosis of the infants is related to early diagnosis and medical intervention. Clinically WMI has no obvious signs and symptoms, so it is hard to diagnosis.ultrasound has become an effective method to make early diagnosis, disease judgment and prognosis due to its simple operation without moving the infants. Interleukin-6(IL-6) is one of multifunctional cytokines in inflammation regulation and immune response produced by monocyte, B cell, T cell, fibroblast and endothelial cells, while created by astrocyte and microglia in the brain tissue. It is reported that NSE is the index of sensitivity and idiosyncrasies reflecting the brain injury degree and will rise high when the brain injury is serious. Research in this paper is made to study ultrasound by detecting level of ultrasound, IL-6and neuron-specific enolase (NSE), to analyze its practical meaning and application prospect in early diagnosis of white matter injury for the preterm infants.Currently, medicine for white matter injury is still on exploration. GM-1is one of ganglioside in ganglion series, and takes an important role in neuron generation, growth and differentiation. GM-1could achieve the goal of treatment by increasing blood flow in the brain tissue, boosting axon growth, improving the neurocyte survival rate, regulating synapse signal transmission, enhancing neurotrophic activity, strengthening neuron reconstruction and helping injury repair work. The study here is to evaluate GM-1treatment and the index in the early stage of white matter injury by having GM-1treatment on the preterm infants with WMI based on routine treatment.[Objective]1.To evaluate the significance of interleukin-6(IL-6)and neuron specific enolase (NSE) in early diagnosis of the matter injury in preterm infants.2.To measure cerebral ultrasound value on early diagnosis and prognosis of preterm infants with white matter injury3.To discuss GM-1treatment on the infants of white matter injury[Method]1Grouping1.1Clinical data:Totally109infants,57male and52female, who were newly born from Jan2011and Oct2011in our hospital are elected. Their gestational ages are33～37weeks and they weight from850-2600g.4infants have not completely treated. So finally105in total,54male and51female, are examined.1.2Grouping1.2.1GroupingDetect by MRI the brains of the preterm infants with less37weeks of gestational age, allocate those without white matter injury to the control group, and select those with white matter injury to observation group and the treatment group by randomization (Random Numbers Table)1.2.2Control group:35infants, who have less37weeks of gestational age, and are found no brain white matter injury by MRI. The ones with infectious diseases and abnormal nervous system are exempted.1.2.3Observation Group:35infants, who have less37weeks of gestational age, and are found brain white matter injury by MRI (Ultrasound gray scale is higher). The ones with infectious diseases and abnormal nervous system are exempted.1.2.4Treatment Group:35infants, who have less37weeks of gestational age, and are found brain white matter injury by MRI (Ultrasound gray scale is higher). The ones with infectious diseases and abnormal nervous system are exempted.The preterm infants in these three groups have no statistical difference in terms of Sample size,birth days, gestational age, birth mode, birth weight and sex.(P>0.01)2. Treatment2.1Foundational Treatment2.1.1Good Care:①Supply oxygen in need②Warming;③Feeding scientifically④Supervising disease frequently.2.1.2Three projects supportive therapy:①Keep good breathing state and maintain blood and PH of normal value;②Keep enough blood flow through whole body and all organs, and maintain cardiac rate and blood press at normal condition;③Keep blood glucose at5.0mmol/L needed by normal metabolism of neural.2.1.3Three symptomatic treatment:①Prevent convulsion;②Decrease inner cerebral pressure;③Avoid brainstem symptoms2.2Trial MethodInfants in the control group receive no treatment;Infants in the treatment group receive basic treatment;GM-1Treatment Group:on the basis of foundational treatment, have vein transfusion by20mg GM-1(manufactured by TRB company in Argentina, specification20mg/2ml) with20milliliter gluconate solution of50g/L,1/day,14/treatment period.3.Observation Methods3.1Sample collection:2ml vein blood are taken from the sterns of three groups of preterm infants separately, placed in room temperature, centrifuged at the rate of2000r/min in normal temperature, divided from blood serum, and then cooled under -80℃for test.3.2Sample test:IL-6and NSE are produced by ADL Company in USA, then analyzed by the multifunctional immunofluorescence analysis system and tested by ELISA method strictly according to the instruction in the manual.3.3Cerebral ultrasound:With GE VOLUSON730EXPERT machine, have cerebral ultrasound by setting the same parameter (frequency of sector scan indicator is5～9mHz), to check the infants in two groups in1st day,7th day and14th day after birth, and to get sagittal-scanned pictures of central and lateral ventricle. If the echo of whit matter is strange, then the result is abnormal.4.Statistics methodCreate data base by statics software SPSS19.0. Take Analysis of Variance to check comparison between3groups and take Welch to test when variances are unequal. Use LSD to check comparison between2groups and use Dunnett T3to test when variances are unequal. a=0.01as the inspection level, P<0.01show it is statically significant.4infants are not taken as observation targets since they give up treatment and have not finished experiment.[Result]1.They are statistically significant as far as day-old age, gestational age, weight and sex are concerned.(P>0.01)2.IL-6and NSE in the observation group and the treatment group are obviously higher than those in control group in1st、7th day and14th,and ultrasound gray scale is also much higher, comparing with those of the control group, which has statistic significance (P<0-01).3.After treatment, average NSE and IL-6index of the treatment group were evidently lower in7th day and14th day after birth, and ultrasound gray scale is also much lower, comparing with those of the observation group, which has statistic significance (P<0.01).[Conclusions]1.The levels of IL-6and NSE in the preterm infants with white matter injury in the treatment group were higher than those in control group, so it is clinically significant to measure the IL-6and NSE level in the preterm infants is for the diagnosis of WMI and its treatment.2.Cerebral ultrasound and NSE could be taken as powerful evidence in early diagnosis and prognosis of preterm infants with white matter injury.3.Cerebral ultrasound and NSE could be taken as powerful evidence in early diagnosis and prognosis of preterm infants with white matter injury. |
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