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：

缺氧缺血性脑病; 新生儿; 胰岛素样生长因子1; 白介素17; 白介素23; 预后;

Keywords：

Hypoxic-ischemic encephalopathy; Newborns; Insulin-like growth factor 1; Interleukin-17;Interleukin-23; Prognosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.103

Funds：

河北省2020年度医学科学研究课题计划（20200530）

摘要：

目的 探讨血清胰岛素样生长因子1(IGF-1)、白介素(IL)-17、IL-23水平与新生儿缺氧缺血性脑病(HIE)患儿疾病严重程度及预后的关系。方法 选取2019年7月至2021年7月河北北方学院附属第一医院儿内科收治的新生儿HIE患儿87例作为研究对象,参照改良的Sarnat标准判断疾病严重程度,并将患儿分为轻-中度组(n=52)和重度组(n=35);另选择同期本院正常足月新生儿87例作为对照组。采用酶联免疫吸附试验检测新生儿入组1 d内血清IGF-1、IL-17、IL-23水平;新生儿HIE患儿血清IGF-1、IL-17、IL-23水平与疾病严重程度的关系采用Spearman秩相关分析;绘制ROC曲线以评价血清IGF-1、IL-17、IL-23水平及三者联合对新生儿HIE患儿预后的预测价值。结果 轻-中度组和重度组血清IGF-1水平低于对照组,血清IL-17、IL-23水平高于对照组(P<0.05);重度组血清IGF-1水平低于轻-中度组,血清IL-17、IL-23水平高于轻-中度组(P<0.05)。Spearman秩相关分析结果显示,新生儿HIE患儿血清IGF-1水平与疾病严重程度呈负相关(rs=-0.572,P<0.001),血清IL-17、IL-23水平与疾病严重程度呈正相关(rs值分别为0.511、0.558,P值均<0.05)。87例患儿中,预后不良23例。预后良好患儿血清IGF-1水平高于预后不良患儿,血清IL-17、IL-23水平低于预后不良患儿(P<0.05)。ROC曲线分析结果显示,三者联合预测HIE患儿预后的AUC为0.895,分别大于血清IGF-1(AUC=0.785)、IL-17(AUC=0.655)、IL-23(AUC=0.710)水平单独预测HIE患儿预后的AUC(P<0.05)。结论 血清IGF-1水平新生儿HIE患儿疾病严重程度呈负相关,血清IL-17、IL-23水平与新生儿HIE患儿疾病严重程度呈正相关,且三者联合对新生儿HIE患儿预后具有一定预测价值。

Abstract：

【Abstract】　Objective To investigate the relationship between serum levels of insulin-like growth factor 1 (IGF-1) ,interleukin (IL) -17, IL-23 and disease severity and prognosis of neonatal hypoxic ischemic encephalopathy (HIE) . MethodsA total of 87 newborns with HIE treated in the Department of Pediatrics of the First Affiliated Hospital of Hebei North Universityfrom July 2019 to July 2021 were selected as the research objects. The disease severity was judged according to the improvedSarnat standard, and the newborns with HIE were divided into mild to moderate group (n=52) and severe group (n=35) ; another 87normal full-term newborns in the same period of our hospital were selected as the control group. The serum levels of IGF-1, IL-17 and IL-23 were detected by enzyme-linked immunosorbent assay within 1 day of enrollment; the relationship between serumlevels of IGF-1, IL-17, IL-23 and disease severity in children with neonatal HIE was analyzed by Spearman rank correlation;ROC curve was drawn to evaluate the prognostic value of serum levels of IGF-1, IL-17, IL-23 and their combination for neonatalHIE. Results The serum IGF-1 level in mild to moderate group and severe group was lower than that in control group, and theserum levels of IL-17 and IL-23 were higher than those in control group (P <0.05) ; the serum IGF-1 level in severe group waslower than that in mild to moderate group, and the serum levels of IL-17 and IL-23 were higher than those in mild to moderategroup (P <0.05) . Spearman rank correlation analysis showed that the serum IGF-1 level was negatively correlated with thedisease severity in newborns with HIE (rs=-0.572, P <0.001) , and the serum levels of IL-17 and IL-23 were positively correlatedwith the disease severity (rs values were 0.511 and 0.558, respectively, both P values were<0.05) . Among the 87 children, 23had poor prognosis. The serum IGF-1 level in newborns with good prognosis was higher than that in newborns with poor prognosis,and the serum levels of IL-17 and IL-23 were lower than those in newborns with poor prognosis (P <0.05) . ROC curve analysisresults showed that the AUC of their combination for predicting the prognosis of children with neonatal HIE was 0.895, which washigher than that of serum levels of IGF-1 (AUC=0.785) , IL-17 (AUC=0.655) and IL-23 (AUC=0.710) , respectively (P <0.05) .Conclusion The serum IGF-1 level is negatively correlated with the disease severity in newborns with HIE, and the serumlevels of IL-17 and IL-23 are positively correlated with the disease severity, the combination of the three has a certain predictivevalue for the prognosis of children with neonatal HIE.

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