新生儿缺氧缺血性脑病血清和脑脊液中胰岛素样生长因子-Ⅰ水平变化及相关性研究

Changes and correlations of serum and CSF insulin-like growth factor- I levels in neonates with hypoxic-ischemic encephalopathy

目的观察新生儿缺氧缺血性脑病(HIE)血清、脑脊液中胰岛素样生长因子-I(IGF-I)水平的变化及相关性,探讨IGF-I在新生儿HIE发病机制及预后中的作用。方法用放射免疫法(RIA)检测 41例HIE组新生儿生后12 h-24 h及10 d-12 d血清、脑脊液及10例正常足月新生儿(对照组)血清中 IGF-I的水平变化。结果①生后12 h-24 h,轻、中、重度HIE组血清IGF-I的水平分别为(32．94± 8.43)ng／ml,(22．56土5．51)ng／ml,(15．77土3．60)ng／ml,明显低于对照组(79．28士13．28)ng／ml(P< 0.01);且HIE程度越重,IGF-I的水平越低(P<0．05)。②生后10d-12d,轻、中度HIE组及重度HIE无症状组血清中IGF-I的水平分别为(67．22±21．52)ng／ml,(68．54±22．88)ng／ml,(52．58土14．11) ng／ml,分别较各组生后12 h-24 h的水平增高(P<0．01),仍低于对照组(P<0．01),其脑脊液中的水平分别为(6．18土0．87)ng／ml,(5．74±0．94)ng／ml,(5．08±0．87)ng／ml,也较生后12 h-24 h时的水平,分别为(4．43±1．16)ng／ml,(3．19±0．84)ng／ml,(1．97±0．45)ng／ml均明显增高(P<0．01);重度HIE有症状组血清和脑脊液的IGF-I水平分别为(22．49±10．58)ng／ml和(2．26±0．70)ng／ml,虽较生后12 h -24 h增高,分别为(14．22±3．37)ng／ml,(1．87±0．80)ng／ml,但差异无显著意义(P>0．05),然而却明显低于其他各组的水平(P<0．01)。③HIE组血清与脑脊液的IGF-I水平呈正相关关系(r=0．84,P< 0．05)。结论 IGF-I是一种重要的神经保护因子,其水平的改变可能与新生儿HIE的发生、发展及预后有关。

Objective To investigate the changes and correlations of .serum and cerebrospinal fluid （CSF） insulin-like growth factor-I （IGF-I ） levels in neonates with hypoxic ischcmic enccphalopathy （HIE） and to investigate its effects on HIE. Methods Both serum and CSF IGF-I levels in 41 neonates with HIE and serum IGF-I levels in 10 normal neonates were measured by RIA at 12-24 hrs and 10-12 ds of life, Results （1）During postnatal 12-24 hrs, the serum IGF-I levels were 32.94±8. 43ng/ml, 22.56± 5.51ng/ml and 15.77±3. 60ng/ml in mild, moderate and severe HIE groups , respectively, which were significantly lower than those in control group（79.28± 13.28 ng/ml）（P〈0.01 ）,and the more severe HIE was, the lower of IGF-I levels （P〈0.05）.（2） During postnatal 10to 12 days, the serum levels of IGF- I in mild, moderate HIE and in severe HIE group who have no neurological symptoms or signs were significantly elevated compared with the HIE groups of postnatal 12 hrs -24hrs （P〈0.01）and there were no significant differences in the mild, moderate HIE （67. 22±21. 52 ng/ml, 68. 54±22. 88 ng/ml, respectively） and in severe HIE group who have no symptoms or signs （52.58±14. 11 ng/ml） （19〉0.05）. The CSF IGF- I levels were 6. 18±0.87 ng/ml in mild, 5.74±0.94 ng/ml in moderate and 5.08±0. 87 ng/ml in severe HIE group who have no neurological symptoms or signs respectively at posmatal 10 12days, which were significantly increased compared with their levels at posmatal 12-24 hrs（4.43±1.16 ng/ml, 3. 19 ± 0. 84ng/ml, 1. 97 ± 0. 45ng/ml, respectively） （P 〈 0. 01）. However, there were no significant differences in serum and CSF IGF-I levels between sevcr HIE group who have symptoms or signs at postnatal 10-12ds and 12-24hrs groups（P〉0.05）, （3） A positive correlation were shown between the serum and CSF IGF- I levels in HIE groups（r=0.84,P〈0.05）. Conelusion IGF-I is an important neuroproteetive factor and it＇s changes of levels in serum and in CSF might be associated with the pathogenesis and prognosis of neonatal HIE.