胰岛素样生长因子-1在新生儿高胆红素血症中的变化及意义

Serum levels of insulin-like growth factor-1 in neonates with hyperbilirubinemia

摘要:

目的：胰岛素样生长因子-1(IGF-1)是神经系统必需的调节因子，目前少有报道其与高胆红素血症之间的关系。该文主要通过测定高胆红素血症（高胆）新生儿血清中IGF-1水平及新生儿神经行为评分(NBNA)来探讨IGF-1与高胆的关系及其临床意义。方法：应用电化学发光分析法检测57例高胆新生儿和 25例正常新生儿血清中IGF-1 浓度，同步测定血清总胆红素(TSB)、未结合胆红素(USB)及白蛋白(ALB)含量，计算USB与ALB比值(B/A)，并行新生儿 NBNA 评分。高胆组按血清TSB值221~256 μmol/L，257~342 μmol/L，＞342 μmol/L分为轻、中、重三组；对照组TSB ＜85 μmol/L。结果：轻、中、重高胆患儿血清IGF-1浓度均值分别为39.38±8.42，30.77±4.65，26.34±2.05 ng/L，较对照组50.16±15.73 ng/ L明显降低,在轻、中、重高胆组间IGF-1浓度差异存在显著性(P＜0.01)，其值随着胆红素的升高而降低；轻、中、重高胆组NBNA评分均值分别为35.01±2.26，32.45±2.74，26.77±5.02，明显低于对照组38.24±0.78(P＜0.01)，高胆各组间差异也有显著性(P＜0.01);血清IGF-1 浓度与NBNA评分呈正相关(r=0.603, P＜0.01)，与B/A值呈负相关(r=-0.483, P＜0.01)。结论：高胆患儿血清IGF-1浓度显著降低,降低程度与血清胆红素水平有关；IGF-1可能与新生儿胆红素脑损伤密切相关。［中国当代儿科杂志，2009，11（5）：357-360］

Abstract:

OBJECTIVE: Insulin-like grouth factor-1 (IGF-1) is polypetide hormone that has demonstrated effects on neural cells. Up to now, there is few reports about the relation between serum IGF-1 and brain damage in neonates with hyperbilirubinemia. This study explored the potential role of serum IGF-1 in neonatal hyperbilirubinemia. METHODS: Serum levels of IGF-1 were measured using ECLIA in 57 term neonates with hyperbilirubinemia and 25 normal term neonates. Meanwhile, total serum bilirubin (TSB), unconjugated bilirubin (USB) and serum albumin (ALB) contents were measured by the automatic biochemistry analyzer and the ratio of USB/ALB (B/A) was calculated. The hyperbilirubinemia group was classified into three subgroups based on serum TSB levels: mild (221-256 μmol/L), moderate (257-342 μmol/L) and severe (>342 μmol/L). Serum TSB levels in the 25 normal neonates were less than 85 μmol/L (control group). NBNA was performed on the day of serum sample collection. RESULTS: Serum IGF-1 levels in the mild, moderate and severe hyperbilirubinemia groups (39.38±8.42, 30.77±4.65 and 26.34±2.05 ng/L, respectively) were obviously lower than those in the control group (50.16±15.73 ng/L) (P<0.01). There were significant differences among the three hyperbilirubinemia subgroups in serum IGF-1 levels (P<0.01). Mean NBNA scores in the mild, moderate and severe hyperbilirubinemia groups (35.01±2.26, 32.45±2.74 and 26.77±5.02, respectively) were significantly lower than those in the control group (38.24±0.78) (P<0.01). Significant differences in the NBNA scores were noted among the three hyperbilirubinemia subgroups (P<0.01). Serum IGF-1 levels were positively correlated to NBNA scores (r=0.603, P<0.01) and negatively correlated to the ratio of B/A (r=-0.483, P<0.01). CONCLUSIONS: Serum IGF-1 levels decreased obviously in neonates with hyperbilirubinemia and correlated to the severity of disease. IGF-1 might be associated with bilirubin-induced brain damage.［Chin J Contemp Pediatr, 2009, 11 (5):357-360］