高胆红素血症早产儿血清胰岛素样生长因子-1水平的变化及其临床意义

目的 探讨高胆红素血症(高胆)早产儿血清胰岛素样生长因子-1(IGF-1)水平的变化及其临床意义.方法 应用电化学发光免疫法检测64例高胆早产儿(实验组)和20例非高胆早产儿(对照组)血清IGF-1、神经元烯醇化酶(NSE)水平,同步测定其血清总胆红素(TSB)水平,并比较组间IGF-1、NSE、TSB水平的差异及其相关性.高胆组按TSB170～256μmol·L-1,257～342μmol·L-1,＞342μmol ·L-1分为轻、中、重3组.结果 轻、中、重高胆早产儿血清IGF-1水平分别为(25.38±5.42)μg·L-1、(21.77±8.65)μg·L-1、(18.34±4.05)μg·L-1,较对照组[(27.14±3.72)μg·L-1]明显降低,轻、中、重高胆组间IGF-1水平存在统计学差异(Pa＜0.01),其值随着胆红素水平变化而变化；高胆组NSE水平分别为(25.01±2.26)μg·L-1、(30.45±2.74)μg·L-1、(33.76±5.02)μg·L-1,明显高于对照组[(11.14±4.68)μg·L-1](P＜0.01),各组间差异均有统计学意义(Pa＜0.01)；血清IGF-1水平与TSB、NSE均呈负相关(r=-0.562、-0.503,Pa＜0.01).结论 IGF-1与高胆早产儿的预后密切相关,可作为判断高胆早产儿是否存在脑损伤的生化指标之一.

Change of Serum Insulin - Like Growth Factor - 1 in Premature Infants with Hyperbilirubinemia and Its Clinical Significance

Objective To study the change of serum insulin-like growth factor-1(IGF-1) in premature infants with hyperbilirubinemia and its clinical significance. Methods Serum levels of IGF-1 and neuron-specific enolase(NSE) were measured by electric-chemiluminescent immunoa-ssay,and total serum bilirubin(TSB) was detected in 64 premature infants with hyperbilirubinemia(experiment group) and 20 premature infants without hyperbilirubinemia(control group),respectively.The levels of TSB,170-256 μmol·L-1 were defined as mild hyperbilirubinemia group,257-342 μmol·L-1 as moderate group,and>342 μmol·L-1 as severe group. Results 1.The levels of IGF-1 in serum in hyperbilirubinemia groups[(25.38±5.42) μg·L-1,(21.77±8.65) μg·L-1,(18.34±4.05)μg·L-1] were decreased obviously than that in control group[(27.14±3.72) μg·L-1](P<0.01) and there were significant differences among the experiment groups(Pa<0.01).2.The mean NSE in experiment groups [(25.01±2.26) μg·L-1,(30.45±2.74) μg·L-1,(33.76±5.02) μg·L-1] were significantly higher than that in control group[(11.14±4.68) μg·L-1],and there were significant differences among experiment groups(Pa<0.01).3.Serum IGF-1 levels were negatively correlated to NSE and TSB(r=-0.562,-0.503,Pa<0.01). Conclusions IGF-1 may be closely correlated to the prognosis of premature infants with hyperbilirubinemia.IGF-1 levels can act as the biochemical indicator for bilirubin-induced brain damage in premature infants.