Chiaretti Antonio, Genovese Orazio, Riccardi Riccardo, Di Rocco Concezio, Di Giuda Daniela, Mariotti Paolo, Pulitanò Silvia, Piastra Marco, Polidori Giancarlo, Colafati Giovanna Stefania, Aloe Luigi
Pediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy.
Neurol Res. 2005 Oct;27(7):741-6. doi: 10.1179/016164105X35611.
Hypoxic-ischemic brain injuries in childhood are associated with poor neurological outcome. Unfortunately, no new therapeutic approaches have been proposed. Recently, animal studies show that nerve growth factor (NGF) can reduce neurological deficits following hypoxic-ischemic brain injuries. The objective of this study is to demonstrate the therapeutic effects of intraventricular NGF infusion in severe post-ischemic damage.
Two infants, aged 9 and 8 months, with hypoxic-ischemic brain damage, secondary to prolonged cardiorespiratory arrest and stabilized after the conventional treatment, were treated with intraventricular NGF infusion. Before the therapy both infants were comatose with asymmetrical tetraparesis; their Glasgow Coma Scale (GCS) was 4 and 5, respectively. One month after the treatment, their GCS was 8 and 9, respectively. EEG examinations performed after the NGF infusion showed an increased alpha/theta ratio. MRI showed a reduction of malacic areas in the brain. A SPECT study, performed only in one infant, demonstrated that the NGF treatment resulted in an improvement of regional cerebral perfusion in right temporal and occipital cortices.
The drug utilized was 2.5S NGF purified and lyophilized from male mouse submaxillary glands. NGF infusion was started about 30 days after the hypoxic-ischemic brain injury. 0.1 mg NGF was administered via the external drainage catheter into the right cerebral ventricle once a day for 10 days consecutively.
Our observations are interesting, but further studies are necessary to confirm the effects of NGF in hypoxic-ischemic brain injuries in infants.
儿童缺氧缺血性脑损伤与不良神经学预后相关。遗憾的是，尚未提出新的治疗方法。最近，动物研究表明神经生长因子（NGF）可减轻缺氧缺血性脑损伤后的神经功能缺损。本研究的目的是证明脑室内注入NGF对严重缺血后损伤的治疗效果。
两名分别为9个月和8个月大的婴儿，因长时间心肺骤停继发缺氧缺血性脑损伤，经传统治疗后病情稳定，接受了脑室内NGF注入治疗。治疗前，两名婴儿均昏迷，伴有不对称性四肢轻瘫；他们的格拉斯哥昏迷量表（GCS）评分分别为4分和5分。治疗1个月后，他们的GCS评分分别为8分和9分。注入NGF后的脑电图检查显示α/θ比值增加。MRI显示脑内软化灶面积减小。仅对一名婴儿进行的单光子发射计算机断层扫描（SPECT）研究表明，NGF治疗使右侧颞叶和枕叶皮质的局部脑灌注得到改善。
使用的药物是从雄性小鼠颌下腺纯化并冻干的2.5S NGF。在缺氧缺血性脑损伤后约30天开始注入NGF。每天通过外置引流导管向右侧脑室注入0.1 mg NGF，连续10天。
我们的观察结果很有趣，但需要进一步研究以证实NGF对婴儿缺氧缺血性脑损伤的作用。
