| Objectives:To observe the levels of insulin-like growth factor-1（IGF-1）,interleukin-17（IL-17）,and interleukin-23（IL-23）in serum of neonates with different degrees of hypoxic-ischemic encephalopathy（HIE）.Compare the expression of IGF-1,IL-17,and IL-23 in the acute and recovery phases of HIE,and evaluating the correlation of neonatal behavioral nerve score（NBNA）and the expression of IGF-1,IL-17,IL-23.To provide a reliable basis for elucidating the pathogenesis,early clinical diagnosis,disease assessment and prognosis of neonatal HIE.Methods:From December 2017 to December 2018,60 cases of HIE patients admitted to the neonatal department of the First Hospital of Hebei Medical University were selected as the HIE group.According to the"Diagnosis and Clinical Grading Standards of HIE"developed by the Neonatal Group of the Pediatrics Branch of the Chinese Medical Association in 2005[1],it is divided into 23 cases of mild HIE,21 cases of moderate,and severe 16 cases.32 cases of normal newborns born in the same hospital were randomly selected as the control group.The newborns in the normal control group received 2 m L of radial arterial blood at 24 h after birth,and the children of HIE group received 2 m L of radial arterial blood at 24 h and 7days after birth.Enzyme-linked immunosorbent assay（ELISA）was used to measure the serum levels of IGF-1,IL-17,and IL-23;Changes in the frequency of Th17 cells in the HIE group and the control group and changes in the frequency of Th17 cells between the HIE groups.Correlation analysis of serum IGF-1,IL-17,and IL-23 levels with HIE clinical scale and neurometric score scale（NBNA）.Results:1.Compared with the control group,the levels of serum IGF-1in the children with HIE were significantly lower than the normal control group（P<0.05）,and the levels of IL-17 and IL-23 were significantly higher than the normal control group（P<0.05）;2.Compared with the mild HIE group,the serum IGF-1 levels were lower in the moderate and severe HIE groups,and the levels of IL-17 and IL-23 were higher（P<0.05）;3.The level of IGF-1 in children with HIE in the acute phase decreased significantly with the severity of HIE;the levels of IL-17 and IL-23 increased significantly with the severity of HIE（P<0.05）;During the recovery period of children with HIE,the levels of serum IGF-1 in children with mild,moderate and severe HIE were significantly higher than those in the acute stage,and the levels of IL-17 and IL-23 were significantly lower than those in the acute stage（P<0.05）;4.The number of Th17 cells at 24 hours after birth in the peripheral blood of the HIE group was significantly higher than that in the control group（P<0.05）.With the increase of the degree of HIE disease,the peripheral blood Th17 cell count gradually increased（P<0.05）;5.Serum levels of IGF-1,IL-17and IL-23 in children with HIE were significantly correlated with NBNA scores.6.Serum IGF-1 levels were significantly positively correlated with NBNA scores in children with HIE（r=0.84,P<0.05）,and IL-17 and IL-23levels were significantly negatively correlated with NBNA scores（r=-0.77,P<0.05;r=-0.62,P<0.05）.Conclusions:1.The serum IGF-1 concentration in the HIE group was significantly lower than that in the normal control group,while the levels of IL-23 and IL-17 were higher than those in the normal control group.It is suggested that IGF-1,IL-23 and IL-17 participate in the pathological process of children with HIE.2.Changes in the levels of IGF-1,IL-23,and IL-17 are closely related to the severity of HIE.The heavier the disease,the lower the IGF-1 level,the higher the IL-23,IL-17 levels.Dynamic monitoring of IGF-1,IL-23,and IL-17 levels can be used as an indicator to help diagnose the severity of HIE disease.3.The level of IGF-1 in HIE recovery period is higher than that in acute phase,and the levels of IL-23 and IL-17 are lower than those in acute phase,which indicates that there are significant differences in IGF-1,IL-23 and IL-17 levels in different onset periods;IGF-1,IL-23,and IL-17 can be used as indicators to predict the early diagnosis and treatment of HIE.4.Serum IGF-1 levels were significantly positively correlated with NBNA scores in children with HIE（r=0.84,P<0.05）,and IL-17 levels were significantly negatively correlated with NBNA scores（r=0.87,P<0.05）.There was also a significant negative correlation between L-23 levels and NBNA scores（r=0.82,P<0.05）,suggesting that IGF-1,IL-23,and IL-17levels can be used as indicators for judging the prognosis of HIE.5.Peripheral blood Th17 cell counts were significantly increased at 24hours after birth in HIE groups,and the differences were statistically significant（F=28.392,P<0.05）.Th17 cell counts gradually increased with the severity of the disease,showing Th17 The cell count is closely related to the severity of HIE,suggesting that the measurement of Th17 cell count has certain reference value for judging the clinical division of children with HIE. |
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