血清脂联素及胰岛素样生长因子-1水平变化在新生儿缺氧缺血性脑病中的临床意义

摘要

目的：探讨胰岛素样生长因子-1（IGF-1）和脂联素（APN）的变化在新生儿缺氧缺血性脑病（HIE）中的临床意义。方法足月新生儿88例，于出生时取脐带血及出生后3～5 d（急性期）及10～14 d（恢复期）取外周静脉血检测血清APN及IGF-1水平。于生后足月时根据诊断进行分组，其中健康足月新生儿20例为对照组，HIE的足月新生儿68例，分为HIE重度组（n＝20）、HIE中度组（n＝25）和HIE轻度组（n＝23）3个亚组，比较4组的APN及IGF-1水平；分析HIE新生儿不同时期APN和IGF-1水平的相关性。结果4组间APN和IGF-1水平比较，差异有统计学意义（P＜0．05），其中HIE重度组及中度组均低于对照组（P＜0．05），而HIE轻度组与对照组比较差异无统计学意义（P＞0．05），HIE重度组均低于中度组，中度组低于轻度组（P＜0．05）；4组各时间点的APN和IGF-1水平比较，差异有统计学意义（P＜0．05）。 HIE新生儿出生时和急性期的APN与IGF-1水平呈正相关（P＜0．05），而恢复期两者无相关性（P＞0．05）。结论 APN和IGF-1水平变化与新生儿HIE的发生发展密切相关，对于临床诊断和病情发展具有一定提示作用。%Objective To explore the clinical significance of level variation of insulin-like growth factor-1(IGF-1) and adiponectin (APN) in neonates with hypoxic-ischemic encephalopathy(HIE).Methods A total of 88 term neonates were enrolled.The cord blood at birth,peripheral venous blood at postnatal 3-5 days(acute period) and postnatal 10-14 days(recovery period) were collected to detect the serum levels of APN and IGF-1.All neonates were grouped when aged one month according to the diagnosis .And 20 healthy term neonates were taken as control group.Another 68 term neonates with HIE were divided into three subgroups including severe HIE group (n=20), moderate HIE group(n=25) and mild HIE group(n=23).The levels of APN and IGF-1 were compared among four groups.And the correlation of APN level with IGF-1 level was analyzed in different stages of neonates with HIE .Results There were significant differences in APN and IGF-1 levels among four groups(P<0.05).The levels of APN and IGF-1 were lower in the severe HIE group or moderate HIE group compared to those in the control group(P<0.05),but no significant difference was observed in the level of APN or IGF-1 between mild HIE group and control group (P<0.05).The APN and IGF-1 levels in the severe HIE group were lower than those in the moderate group,and the levels in the moderate HIE group were lower than those in the mild HIE group (P<0.05).There were significant differences in the levels of APN and IGF-1 at each time point among four groups (P<0.05).Positive correlation was observed between APN and IGF-1 levels in the neonates with HIE at birth and during the acute period (P<0.05),but no correlation between APN and IGF-1 levels was observed during the recovery period (P>0.05).Conclusion The level variation of APN and IGF-1 is closely associated with the occurrence and progression of neonatal HIE,and has suggestive effects on the clinical diagnosis and disease progression .