Serum Level Of Insulin-like Growth Factor-1and Its Clinical Sign-Ificance In Hypoxic-ischemic Encephalopathy

BackgroundHypoxic-ischemic encephalopathy is due perinatal hypoxia asphyxia hypoxic-ischem-ic damage.It is caused by one of the acute neonatal death and chronic central nervous system injuries.Dynamic monitoring of serum IGF-1levels in HIE, combined with synchronous NBNA scores and imaging examinations, can determine the development of HIE conditions.ObjectiveTo dynamically monitor the changes of neonatal serum insulin-like growth factor-1(IGF-1) level and neonatal behavioral neurological assessment (NBNA) score and their correlation; to observe the changes in the extent (CT value) of hypoxic-ischemic encephalopathy (HIE), low-density range and form of the white matter; to explore the value of serum IGF-1level in early diagnosis of neonatal HIE and the correlation of changes in serum IGF-1level with the severity and prognosis of HIE; to investigate the roles of NBNA score and CT image in the development and prognosis of HIE.Methods1.124HIE neonates admitted in the Neonatology of Nanyang First People’s Hospital in Henan Province from January2012to June2013in HIE were as the HIE group, who were divided into mild, moderate and severe groups according to the "HIE Diagnostic Standards and Classification" revised in Changsha Conference.68healthy neonates born in the same period were as the control group. The gender, gestational age and birth weight in each HIE group were not significantly different from the control group.2.2ml of venous blood was collected from neonates in HIE groups after the birth for12-24h (acute phase) and10～14d (recovery phase);2ml of umbilical cord blood was collected from neonates in the control group. The changes of serum IGF-1levels were quantitated by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA).3. The neonates in HIE groups and the control group were all given NBNA scores on the day of blood sampling, and the results of NBNA scores were recorded.4. All of the HIE neonates underwent cranial CT scan with the dual-source800-slice CT scanner from Siemens in Germany after the birth for4～7days.5. SPSS16.0software was used for statistical analysis of the resulting data. The experimental data were expressed as mean±standard deviation (x±s).Results1. The serum IGF-1levels in mild, moderate and severe HIE groups at the acute phase were significantly different from the control group (F=7.057, P<0.05). The serum IGF-1levels in mild, moderate and severe HIE groups at the recovery phase were significantly different from the acute phase (mild group:t=24.67, P<0.05; moderate group: t=12.83, P<0.05; severe group t=7.41, P<0.05).2. The NBNA scores in mild, moderate and severe HIE groups at the acute phase were significantly different from the control group (F=6.931, P<0.05). The NBNA scores in mild, moderate and severe HIE groups at the recovery phase were significantly different from the acute phase (mild group:t=11.0, P<0.05; moderate group:t=10.56, P<0.05; severe group:t=4.64, P<0.05). The serum IGF-1levels in HIE groups at the acute and recovery phases were significantly positively correlated to NBNA scores (acute phase: r=0.864, P<0.01, recovery phase:r=0.844, P<0.01).3. There were84cases of neonates in HIE groups with the CT value not more than18Hu at the acute phase. There were40,36and22cases of morphological changes appeared in mild, moderate and severe HIE groups, respectively.Conclusion1. The serum IGF-1levels in HIE children are significantly lower than normal newbo-rns. The more severe in the clinical conditions, the lower serum IGF-1levels will be obtai- ned. The serum IGF-1level plays an important role in the early diagnosis of HIE, determi-nation of the severity of disease and improvement of the prognosis.2. Dynamic monitoring of serum IGF-1levels in HIE children, combined with the sy-nchronous NBNA score and imageological examination, can better determine the develop-ment of HIE, thus providing an important basis for determining the prognosis of HIE.3.The changes in serum IGF-1levels may be considered as a regulated target for treat-ment of HIE, thus providing a theoretical basis for treatment of HIE.