| Objective Observe changes of insulin-like growth factor-l( IGF-1) and tumor necrosis factor-oc(TNF-ot) in plasma of neonatal hypoxic-ischemic ecephalopathy (HIE)and the relation between IGF-1 and TNF-a in acute stage and early convalescent of HIE. To investigate the mechanisms of IGF-1 on HIE pathogenesis and the possible causes of it's changing.Methods Plasma levels of IGF-1 and TNF-a were examined in 42 neonates with HIE (26 cases were mild form, 16 cases were moderate\severe form) in acute stage and early convalescent, as compared with the control group (20 cases of normal full-term newborns) . The plasma levels of IGF-1 were examined by means of RIA? the plasma TNF-a levels were examined by ELISA. At the same time, 27 cases were given the Neonatal Behavioral Neurological Assessment (NBNA) in convalescent. Relation between the scores and the plasma IGF-1 levels in acute stage were also analysed.Results In acute stage of HIE (including mild and moderate\severe form), plasma IGF-1 level reduced significantly. There was significant difference compared with that of early convalescent (t=8. 078,P<0. 01) and control group (t=11. 663,F<0. 01) . In early convalescent, the IGF-1 level increased, but it hadn't returned to normal. There was difference compared with that of control (t=2. 057, P<0. 05) . In acute stage of mild HIE, plasma IGF-1 level decreased, there was significant difference with that of early convalescent (t=7. 196,P<0. 01) and control group (t = 9. 663,P<0. 01). The level in early convalescent had returned to normal (t=0. 413,P>0. 05). In acute stage of moderate\severe HIE, plasma IGF-1 level decreased seriously, there was significant difference with that of control group 0 = 5. 993,P<0. 01) and early convalescent (t = 11. 171 ,P<0. 01). What's more, it's level decreased mush more than that in acute stage of mild HIE (t==2. 881,P<0. 01). In early convalescent, the IGF-1 level increased, but it was still lower than that in control group (t=4. 510, P<0. 01) and in the early convalescent of mild form (t=3. 058,P<0. 01). In acute stage of HIE(including mild and moderate\severe form), in mild HIE and in moderate\severe HIE, plasma levels of TNF-a had elevated. There was significantly difference compared with that of their early convalescent (z=2. 693,P<0. 01;t=1. 936,P<0. 05;?2. 237,P<0. 05) and control group (t=3. 104,P<0. 01;t=2. 667,P<0. 05;?3. 539,P<0. 01). In early convales-cent, there were no significant differences with that of control group (t=l. 052-1. 238, P>0. 05). In acute stage of moderate\severe HIE, the level of TNF-a increased much more than that of mild form(t=2. 535,P<0. 05). Furthermore, in mild and moderate\ severe HIE, either in acute stage (r=-0. 658, P<0. 01) or in convalescent (r = - 0. 403, P<0. 05), there were significant negative correlation between plasma levels of IGF-1 and TNF-a. There were positive correlation between plasma IGF-1 level in acute stage and the scores of NBNA in convalescent (t=0. 416, P<0. 05).Conclusion 1Plasma level of IGF-1 dramatically decreased in acute stage and returned to normal in convalescent HIE. But in moderate\severe HIE, the time it returned to normal was later than that in mild HIE. 2Plasma level of TNF-a increased in acute stage and the increases was parallel to the severity of HIE. The level of TNF- a returned to normal in early convalescent either in moderate\severe or mild HIE.3Plasma level of IGF-1 was related to that of TNF-a in HIE, Plasma level of IGF-1 in acute stage was also related to the scores of NBNA. 4 All of the above indicated that IGF-1 play a role in the pathogenesis of neonatal HIE. It also suggested that measuring IGF-1 be of great value to estimating the degree and the prognosis of neonatal HIE. |
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