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目的研究急性一氧化碳中毒后迟发性脑病(DEACMP)患者血清胰岛素样生长因子-1(IGF-1)水平的动态变化及其临床意义。方法选择2007年11月—2008年6月在我院住院的33例DEACMP患者,采用酶联免疫吸附法动态测定血清IGF-1水平,用日常生活能力量表(ADL)、长谷川痴呆量表(HDS)、常识-记忆-注意测验(IMCT)动态评估DEACMP患者的病情变化,并与32例急性一氧化碳中毒(ACMP)后未发生DEACMP的患者(AC-MP组)和32例健康体检者(正常对照组)的以上指标进行比较。结果 (1)DEACMP组急性期血清IGF-1水平〔(136.10±51.51)μg/L〕低于正常对照组〔(192.91±145.97)μg/L,P<0.05〕,DEACMP组急性期与ACMP组〔(156.51±93.13)μg/L〕比较,ACMP组与正常对照组比较,差异均无统计学意义(P>0.05)。DEACMP组恢复期血清IGF-1水平〔(187.69±92.46)μg/L〕较急性期升高,差异有统计学意义(P<0.05)。(2)DEACMP组急性期ADL、HDS和IMCT评分与恢复期比较,差异均有统计学意义(P<0.05)。(3)DEACMP组中IGF-1水平与ADL评分呈负相关(r=-0.377,P=0.03)。结论 IGF-1在DEACMP脑损伤中可能起着重要保护作用,血清IGF-1水平可能作为临床转归、疗效判定的指标之一。
Objective To study the dynamic changes of serum insulin-like growth factor-1 (IGF-1) level and its clinical significance in patients with delayed encephalopathy (ACAC) after acute carbon monoxide poisoning. Methods Thirty-three DEACMP patients hospitalized in our hospital from November 2007 to June 2008 were enrolled in this study. The level of serum IGF-1 was measured by enzyme-linked immunosorbent assay (ELISA). The daily living ability scale (ADL), Hasegawa dementia scale (HDS) and memory-attentiveness test (IMCT) were used to dynamically assess the changes of the patients with DEACMP and compared with 32 patients with ACAC who did not develop DEACMP (AC-MP group) and 32 healthy subjects Normal control group) of the above indicators were compared. Results (1) The level of serum IGF-1 in acute phase of DEACMP group was lower than that of normal control group (192.91 ± 145.97 μg / L, P <0.05) (136.10 ± 51.51) μg / L, 〔(156.51 ± 93.13) μg / L〕. There was no significant difference between ACMP group and normal control group (P> 0.05). The level of serum IGF-1 in convalescent phase [(187.69 ± 92.46) μg / L] in DEACMP group was higher than that in acute phase, the difference was statistically significant (P <0.05). (2) The difference of ADL, HDS and IMCT scores in acute phase of DEACMP group and recovery period were statistically significant (P <0.05). (3) The level of IGF-1 in DEACMP group was negatively correlated with ADL score (r = -0.377, P = 0.03). Conclusion IGF-1 may play an important protective role in DEACMP brain injury. Serum IGF-1 level may be one of the indicators of clinical outcome and curative effect.