血清IGF-1围术期变异性与脑瘫患儿颈动脉周围交感神经网切除疗效的相关性

目的探讨血清胰岛素样生长因子-1（IGF-1）围术期变异性与脑性瘫痪（CP）患儿颈动脉周围交感神经网切除疗效的相关性。方法选择2019年1月—2022年12月于新疆医科大学第二附属医院行颈动脉周围交感神经网切除术的CP患儿179例作为研究对象，收集所有患儿的临床资料。而后对患儿进行为期6个月的随访，统计随访结束时患儿疗效情况，分析IGF-1变异性与疗效之间的相关性。结果截至2023年6月30日随访结束，179例患儿中，疗效评价为显效61例，有效84例，无效34例，按疗效分为好转组（n=145）及无效组（n=34）。无效组患儿各时间点血清IGF-1、平均值、标准差、变异系数（CV）均显著低于好转组，差异具有统计学意义（P<0.05）。IGF-1（CV）（优势比=0.059）是影响手术疗效的独立保护因素（P<0.05）。IGF-1(CV）对脑瘫患儿手术疗效预测曲线下面积（AUC）优于IGF-1（术前）及IGF-1（术后7 d）（P<0.05），IGF-1(CV）预测准确性显著高于IGF-1（术前）及IGF-1（术后7 d）（P<0.05）。结论围术期IGF-1变异情况与颈动脉周围交感神经网切除术治疗CP患儿的疗效存在相关性。

Objective To explore the correlation between perioperative variability of serum insulin-like growth factor-1(IGF-1) and the efficacy of carotid peripheral sympathetic network resection in children with cerebral palsy(CP). Methods 179 children with CP who underwent carotid sympathetic plexus excision in the Second Affiliated Hospital of Xinjiang Medical University from January 2019 to December 2022 were selected as study subjects. Clinical data of all children were collected. The children were then followed up for a period of 6 months, and the correlation between IGF-1 variability and outcome was analyzed by counting the outcome at the end of the follow-up. Results By the end of the follow-up on June 30, 2023, of the 179 children, 61 were evaluated as effective, 84 were effective, and 34 were ineffective. So they were divided into improvement group(n=145) and ineffective group(n=34) according to therapeutic effect. Serum IGF-1, Mean, SD, coefficient of variation(CV) of children in the ineffective group were significantly lower than those in the improved group at all time points, and the difference was statistically significant(P<0.05). IGF-1(CV) (OR=0.059) was an independent protective factor affecting surgical efficacy(P<0.05). IGF-1(CV) was better than IGF-1(before surgery) and IGF-1(7 days after surgery) in predicting area under curve(AUC) for cerebral palsy children(P<0.05), and the prediction accuracy of IGF-1(CV) was significantly higher than that of IGF-1(before surgery) and IGF-1(7 days after surgery)(P<0.05). Conclusion There is a correlation between perioperative IGF-1 variability and the efficacy of carotid sympathetic plexus excision for children with CP.