The Relationship of Serum Levels of Il-23 Uch-L1 and Mir-424 with Severity of Hypoxic-Ischemic Encephalopathy(Hie)in Full-Term Newborns and the Predictive Value on Prognosis
Objective:To investigate the relationship of serum interleukin-23(IL-23),ubiquitin carboxy-terminal hydrolase L1(UCH-L1)and micrnas 424(miR-424)with the severity of hypoxic-ische-mic encephalopathy(HIE)in full-term neonates and their predictive value on prognosis.Methods:A total of 105 cases of full-term infants with HIE diagnosed in the period from January 2019 to December 2022 were se-lected as the HIE group,which were further divided into mild(37 cases),moderate(43 cases),and severe(25 cases)subgroups according to the HIE grading criteria.Additionally,105 cases of full-term healthy new-borns from the same period were selected as the control group.Venous blood samples were collected from all subjects within one day of enrollment,and serum levels of IL-23 and UCH-L1 were measured using enzyme-linked immunosorbent assay(ELISA),while serum miR-424 levels were determined using real-time quanti-tative polymerase chain reaction(qRT-PCR).The serum levels of IL-23,UCH-L1,and miR-424 were compared between the HIE group and the control group,and the correlation between these markers and the se-verity of HIE was analyzed.The HIE group was followed up for one year,and according to the prognosis,they were further divided into the good prognosis subgroup and the poor prognosis subgroup.The serum levels of IL-23,UCH-L1,and miR-424 were compared between these two subgroups,and the predictive value of these markers for prognosis was analyzed.Results:The serum levels of IL-23(68.67±21.29)ng/L and UCH-L1(1.98±0.63)ng/mL in the HIE group were higher than those in the control group(30.06±6.13)ng/L and(0.75±0.24)ng/mL,respectively.Meanwhile,the serum level of miR-424(1.98±0.63)was lower than that in the control group(1.02±0.11)(P<0.05).In the severe HIE subgroup,the serum levels of IL-23(95.21±21.08)ng/L and UCH-L1(2.42±0.46)ng/mL were higher than those in the moderate HIE sub-group(70.49±18.13)ng/L and(2.01±0.40)ng/mL,respectively,and those in the mild HIE subgroup(48.62±14.72)ng/L and(1.65±0.34)ng/mL.The moderate HIE subgroup had higher serum levels of IL-23 and UCH-L1 than the mild HIE subgroup,while the serum level of miR-424(0.53±0.10)was lower than that in the moderate HIE subgroup(0.70±0.12)and mild HIE subgroup(0.84±0.16),with the mod-erate HIE subgroup having lower serum levels of miR-424 than the mild HIE subgroup(P<0.05).Serum levels of IL-23 and UCH-L1 positively correlate with the severity of the disease,while miR-424 levels nega-tively correlate with it(P<0.05).After a 1-year follow-up,1 case was lost.Among the 104 children,82 had a good prognosis and 22 had a poor prognosis.The poor prognosis subgroup had lower Apgar scores at 1 and 5 minutes,as well as lower NBNA scores,and a higher severity of illness compared to the good prognosis subgroup(P<0.05).The serum levels of IL-23(94.41±20.35)ng/L and UCH-L1(2.46±0.62)ng/mL in the poor prognosis subgroup were higher than those in the good prognosis subgroup(61.76±18.74)ng/L and(1.84±0.49)ng/mL,respectively,while miR-424 levels(0.51±0.16)were lower than those in the good prognosis subgroup(0.75±0.20)(P<0.05).Partial correlation analysis showed that,after controlling for other factors,serum levels of IL-23,UCH-L1,and miR-424 were significantly associated with the prog-nosis of full-term HIE patients(P<0.05).The AUCs for predicting the prognosis of full-term HIE patients using serum levels of IL-23,UCH-L1,and miR-424 were 0.815,0.792,and 0.806,respectively.The AUC for combined prediction was 0.913,with a sensitivity of 81.82%and a specificity of 86.59%,which was superior to the predictive value of each individual indicator.Conclusion:Serum IL-23,UCH-L1 and miR-424 are significantly correlated with the severity of full-term neonates with HIE,and have independent prognostic ability,and the combined prognostic value is more reliable.
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