作者：卢艳辉，刘振奎，王雅莉，高娇娇，曹燕玲，孙喜斌，王艳飞，郭卫平

单位：

075000 河北省张家口市，河北北方学院附属第一医院儿内科 通信作者：刘振奎，E-mail：liuzhenkuidr@163.com

Units：

Department of Pediatrics, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China Corresponding author: LIU Zhenkui, E-mail: liuzhenkuidr@163.com

关键词：

缺氧缺血,脑; 胰岛素样生长因子1; 运动神经发育; 行为神经发育;

Keywords：

Hypoxia-ischemia, brain; Insulin-like growth factor 1; Motor nerve development; Behavior nervedevelopment

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.062

Funds：

河北省2020年度医学科学研究课题计划项目（20200530）

摘要：

背景新生儿缺氧缺血性脑病是新生儿围生期窒息引起的严重并发症之一,经临床综合对症治疗后仍有大部分患儿出现神经系统后遗症。胰岛素样生长因子1(IGF-1)是一种神经营养因子,可诱导脑部受损病灶血管新生,保护受损神经组织,其水平变化对新生儿缺氧缺血性脑病患儿近期运动、行为神经发育具有一定影响。目的探讨入院后1 d IGF-1水平与新生儿缺氧缺血性脑病近期运动和行为神经发育情况的关系。方法 选取河北北方学院附属第一医院2019年7月至2020年9月收治的新生儿缺氧缺血性脑病患儿149例为研究对象。根据患儿入院后1 d IGF-1水平变化情况,将其分为升高组(n=89)和未升高组(n=60)。于患儿治愈出院后开始随访至其12月龄。比较两组入组及3、6、12月龄时发育商(DQ),3、6、12月龄时运动、行为神经发育落后发生率,采用Pearson相关分析探讨新生儿缺氧缺血性脑病患儿入院后1 d IGF-1水平与DQ的相关性。结果 149例患儿中,失访12例(升高组7例,未升高组5例),成功随访137例(升高组82例,未升高组55例),随访成功率为91.95%(137/149)。方法与时间在DQ上存在交互作用(P<0.05);方法、时间在DQ上主效应显著(P<0.05)。升高组3、6、12月龄时DQ高于未升高组(P<0.05);升高组、未升高组3、6、12月龄时DQ分别高于本组入组时,6、12月龄时DQ分别高于本组3月龄时,12月龄时DQ分别高于本组6月龄时(P<0.05)。升高组3、6、12月龄时运动、行为神经发育落后发生率低于未升高组(P<0.05)。新生儿缺氧缺血性脑病患儿入院后1 d的IGF-1水平与3、6、12月龄时DQ均呈正相关(r值分别为0.511、0.557、0.605,P值均<0.001)。结论 新生儿缺氧缺血性脑病患儿入院后1 d IGF-1水平升高可能降低近期运动、行为神经发育落后发生率,且其与患儿神经发育情况呈正相关,临床医师可加强IGF-1监测,并采取综合对症支持治疗措施,以提高患儿的救治效果。

Abstract：

【Abstract】　Background Neonatal hypoxic-ischemic encephalopathy is one of the serious complications caused byperinatal asphyxia. After clinical comprehensive symptomatic treatment, most children still have neurological sequelae. Insulin likegrowth factor-1 (IGF-1) is a neurotrophic factor, which can induce angiogenesis in brain damaged lesions and protect damagednerve tissue. Its level changes have a certain impact on the recent motor and behavior nerve development of neonatal hypoxicischemic encephalopathy, which is of great significance to guide the early intervention of the disease. Objective To investigate therelationship between the increase of IGF-1 level one day after admission on the short-term motor and behavior nerve development ofneonatal hypoxic-ischemic encephalopathy. Methods A total of 149 cases of neonatal hypoxic-ischemic encephalopathy treatedin the First Affiliated Hospital of Hebei North University from July 2019 to September 2020 were selected as the research objects.They were followed up to 12 months and 12 cases were lost. According to the changes of IGF-1 level at 1 day after admission, thechildren were divided into elevated group (n=89) and non-elevated group (n=60) . All children were followed up to 12 months ofage after they were cured and discharged from the hospital. The development quotient (DQ) at the time of enrollment and at 3, 6,12 months of age, motor nerve development retardation and behavior nerve development retardation at 3, 6 and 12 months of agewere compared between the two groups. Pearson analysis was used to analyze the relationship between IGF-1 level one day afteradmission and DQ of neonatal hypoxic-ischemic encepnalopaty. Results Among the 149 children, 12 cases were lost to followup (7 cases in the elevated group and 5 cases in the non-elevated group) , and 137 cases were successfully followed up (82 casesin the elevated group and 55 cases in the non-elevated group) . The success rate of follow-up was 91.95% (137/149) . There wasan interaction between method and time on DQ (P < 0.05) . The main effect of method and time on DQ was significant (P < 0.05) .DQ at 3, 6, 12 months of age in elevated group was higher than that in non-elevated group (P < 0.05) . DQ of both groups at 3,6, 12 months of age was higher than that at the time of enrollment, DQ of both groups at 6, 12 months of age was higher than thatat 3 months of age, DQ of both groups at 12 months of age was higher than that at 6 months of age, respectively (P < 0.05) . Theincidence of motor nerve retardation and behavior nerve retardation in the elevated group was lower than that in the non-elevatedgroup (P < 0.05) . IGF-1 level 1 day after admission was positively correlated with DQ at 3, 6, 12 months of age of neonatalhypoxic-ischemic encepnalopaty (r values were 0.511, 0.557, 0.605, respectively, all P values were < 0.001) . Conclusion Theincrease of IGF-1 level 1 day after admission in neonates with hypoxic-ischemic encephalopathy can lower the incidence of motorand behavior nerve development, and it is positively correlated with neurodevelopmental condition. Clinicians can strengthenmonitoring IGF-1, and take symptomatic and supportive measures to improve treatment effect.

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