Umbilical Cord Blood VCAM-1 And E-selection Prediction Of Premature Infant Brain Injury Research

Brain injury in premature infants is a common complication in the preterm survivors and it is one of the key factors which causing the death of infants and nervous system injury of kids. As the fast development of medical diagnosis and treatment technology in recent years,the survival rate of premature infants is significantly increased. But some survivors of premature infants still have serious sequela,such as cognitive disorder, movement disorder and social adaptation obstacles,etc. So the early prevention and early diagnosis of brain injury in premature infants become particularly important for reducing the onset of probability and the nervous system sequela. The common pathogenesis of brain injury in premature infants include: perinatal hypoxic ischemia, infections and inflammation, etc. It is more obviously with the perinatal hypoxic ischemia. The current diagnostic criteria for brain injury in premature infants is mainly refer to the clinical manifestation and imaging examination(as craniocerebral ultrasound, craniocerebral CT, Brain magnetic resonance imaging). In recent years, with the gradual expanding of researching on the pathogenesis of brain injury, more and more people are beginning to focus on the level changing of adhesion molecule in the brain injury and the effects. Human Vascuolar cell adhesion molecule 1 belongs to immunoglobulin super family, it is expression on vascular endothelial cell, which is low expression under normal conditions and surging under the induction of the inflammatory mediators and cytokines, and starting the inflammatory response. The studies of Krupins etc. are shown that VCAM-1 express significantly higher in ischemic vascular endothelial cells. In Animal model of big mouse Cerebral ischemia reperfusion,it is found that the expression of microvascular endothelial cell VCAM-1 in the damage area is increased with the time when cerebral ischemia after one hour. E-selection is also a member of lectin cell adhesion molecule family, belongs to selectin family, only express on the surface of activated vascular endothelial cells. Normally expression is not obvious, when the various inflammatory factors stimulate the vascular endothelial cells, the expression has increased dramatically. There are studies have shown that the soluble E-selection is significantly higher in the serum of the patients with acute cerebral ischemic injury.E-selection. This study tested the content and level of VCAM-1 and E-selection in the cord blood of 84 cases premature infants which born from the pregnant woman with perinatal hypoxia related risk factors.Objective: Ivnvestigateing:(1) The relationship between related risk factors of the perinatal hypoxic ischemia and the premature infant brain injury.(2)The relationship between the level changing of the VCAM-1 and E-selection in the cord blood and the occurrence and illness of the premature infant brain injury.(3)Realizing the affection of the vascular inflammation caused by the VCAM-1 and E-selection in the hypexic-ischemia brain injury. And explaining the relationship between the two factors, In order to providing related experiment basis for clinical diagnosis and treatment.Methods: Select 101 cases premature infants with the related risk factors of the perinatal hypoxic ischemia, who were born from September 2013 to December 2014 in the obstetrical department of Hebei medical university fourth hospital. The related risk factors of the perinatal hypoxic ischemia include: Abnormal fetal intrauterine distress, placenta and umbilical cord, mothers with pregnancy complications and complications(e.g., hypertensive disorder complicating pregnancy. diabetes, anemia, etc.). According to the clinical manifestation of premature infants after birth, examination by craniocerebral ultrasound or brain magnetic resonance imaging diagnosis, it could be executed the diagnosis and the illness situation of the premature infant brain injury: non-brain injury group with 68 cases, brain injury group with 33 cases( 23 cases in mild brain injury and 10 cases in moderately severe brain injury); record the gestational age, birth weight, gender, etc of the selected objects and process the comparative analysis of the experiment. Break hilum instantly after the premature infants delivery, take 2 ~ 3 ml blood from the umbilical vein, placing for 1 hour at room temperature, extract serum 1 ml and put into the EP tube after centrifugal 15 min under the 3000 r/min, stored to waiting detected in refrigerator with- 80 ℃; Detect the VCAM-1 and E-selection level of umbilical cord serum by enzyme linked immunosorbent assay.The experimental data should be using SPSS 19.0 software for statistical analysis and the enumeration data should be using chi-square for examining. The measurement data should be expressed by mean ± standard deviation( sx ±).Comparising two groups using T-text. The comparison between the groups should be analyzed by one-way ANOVA. The Comparison between the two groups should be analyzed by least significant difference, LSD. The comparison between the means of groups of The measurement data in variance of irregular should be using Dunnett’s method; The correlation analysis should be using Pearson method. The statistical treatment should be using two-sided test, when P<0.05 the differences are statistically significant.Results:1 The relationship between related risk factors of the perinatal hypoxic ischemia and the premature infant brain injury: The analysis results of related risk factors of the perinatal hypoxic ischemia of premature infant brain injury is shown: The morbidity of brain injury is significantly higher, which existing fetal distress in uterus, abnormality of placenta and the premature infants from the mother with hypertensive disorder complicating pregnancy. The difference compared with no brain injury group are statistically significant(P<0.05); The morbidity of the brain injury which the group with abnormality of umbilical cord, maternal anemia and diabetes compared with no brain injury group, there is no significant difference(P>0.05).2 The relationship between the brain injury and gestational age, birth weight and gender:The morbidity of brain injury of ≤34w preterm infant group(42.62%)is significantly higher than 35~37w preterm infant group(17.50%). The morbidity of brain injury of extremely low birth weight group(47.73%) is significantly higher than low birth weight group(21.05%). By chi-square examining, the two differences have statistical significance(P<0.05). But in gender balance analysis, there is no significant difference(P>0.05).3 The VCAM-1 and E-selection level testing of cord blood compared with brain injury group and non-brain injury group: The VCAM-1(1437.72±368.75 ng/ml)and E-selection(77.41±19.09 ng/ml)level of cord blood of brain injury group is significantly higher. Compared with the VCAM-1(838.08±265.65 ng/ml)and E-selection(51.81±11.53 ng/ml)level of cord blood of non-brain injury group, the difference are statistically significant.4 The relationship between the illness situation of brain injury of premature infant and the VCAM-1 and E-selection level of cord blood:The VCAM-1 level of the mild brain injury group is 1269.56±281.41 ng/ml and 1824.49±226.80 ng/ml for the moderately severe brain injury group, it is significantly higher than non-brain injury group(838.08±265.65 ng/ml). The differences are statistically significant(P<0.05);The VCAM-1 level of the moderately severe brain injury group is significantly higher than the mild brain injury group(P<0.05). The E-selection level of the mild brain injury group is 70.95±13.66 ng/ml and 92.28±22.06 ng/ml for the moderately severe brain injury group, it is significantly higher than non-brain injury group(51.81±11.53 ng/ml). The differences are statistically significant(P<0.05);The E-selection level of the moderately severe brain injury group is significantly higher than the mild brain injury group(P<0.05).5 The Pearson method correlation analysis of the VCAM-1 and E- selection level of cord blood of the brain injury group: There is a positive correlation between the VCAM-1 level and E- selection level of cord blood. It is statistically significant(R=0.361, P=0.039).Conclusion:1 It is top three risk factors of the premature infant brain injury that existing fetal distress in uterus, abnormality of placenta and the premature infants from the mother with hypertensive disorder complicating pregnancy and closely associated with the premature brain injury incidence.2 The VCAM-1 and E-selection level is significantly higher than non-brain injury group and consistent with the brain injury illness situation. The VCAM-1 and E-selection level of the moderately severe brain injury group is significantly higher than the mild brain injury group. It prompt that the increasing of VCAM-1 and E-selection level is worth for predicting premature brain injury occurs and estimate the illness situation of the brain injury.3 There is a positive correlation between The VCAM-1 level and E-selection level obviously increase and with positive correlation is shown the trend that both of them are consistent in the premature infant brain injury occurred early levels and participate in the the pathological process of early brain injury.