新生儿血清瘦素、生长激素、胰岛素样生长因子-1、胰岛素样生长因子结合蛋白-3水平与宫内发育的关系

Changes of Serum Level of Leptin,Growth Hormone,Insulin Like Growth Factor-1 and Insulin Like Growth Factor Binding Protein-3 in Different Intrauterine Growth and Development Situation

目的探讨瘦素(leptin)、生长激素(GH)、胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)在不同宫内发育状况胎儿中的变化,及对胎儿生长发育调控的作用。方法2004年1月-2006年6月出生早产小于胎龄儿(A组)30例,早产适于胎龄儿(B组)36例,足月小于胎龄儿(C组)32例,足月适于胎龄儿(D组)37例。生后24h内抽取患儿静脉血,用放射免疫法(RIA)检测其血清leptin、GH、IGF-1、IGFBP-3水平,组间比较采用及多元回归相关分析。结果各组新生儿血清leptin、GH、IGF-1、IGFBP-3水平均存在明显差异(Pa<0.05,0.01),各指标基本呈C、A、B、D组次序由低到高,但A组IGF-1与C组差异无统计学意义(P>0.05);在A、B和C组,出生体质量与leptin、IGF-1、IGFBP-3呈正相关(Pa<0.01),而D组出生体质量与IGF-1呈正相关(P<0.01),与其他激素无相关性。结论leptin、IGF-1、IGFBP-3参与宫内发育迟缓儿和早产儿宫内生长发育的调控。IGF-1在早产适于胎龄儿的宫内生长发育中也起调控作用,而leptin、GH、IGFBP-3均不是足月适于胎龄儿生长发育的主要调节因素。

Objective To explore the relationship between the serum level of leptin,growth hormone （GH） ,insulin llke growth factor - 1 （ IGF - 1 ） ,insulin like growth factor binding protein - 3 （ IGFBP - 3 ） and those modulatine effects on fetal growth. Methods One hundred and thirty - five cases of newborns were divided into 4 groups according to the relationship between born weight and gestational age. Group A： premature infants small for gestational age （ SGA）, n = 30. Group B ： premature infants appropriate for gestational age （AGA） ,n = 36. Group C ： mature infants small for gestational age, n = 32. Group D ： mature infants appropriate for gestational age,n = 37. All infants were measured serum leptin, GH, IGF - 1 and IGFBP - 3 level with radiommunosassay （RIA）. Results There were significant difference in the levels of leptin, GH, IGF - 1, IGFBP - 3 as group C 〈 group A 〈 group B 〈 group D （ P 〈 0.05,0.01 ） , but there were no significant difference in the levels of IGF - 1 between group A and C （ P 〉 0.05）. There were positive correlation between levels of leptin, IGF - 1 and IGFBP - 3 in group A, B and C,while,there was positive correlation between only level of IGF - 1 in group D. Conclusions Leptin, IGF - 1 and IGFBP - 3 may play an important role in the fetal growth regulation of premature infants and IUGR infants. IGF - 1 also regulate intrauterine growth of group D. Another side,in group D, Leptin, GH, IGF - 1 and IGFBP -3 don＇t regulate fetal growth.