儿童青少年血清胰岛素生长因子-1及胰岛素因子结合蛋白-3的正常参考值研究

Reference values for serum IGF-1 and IGFBP-3 in children and adolescents

目的建立中国6～18岁年龄段血清胰岛素生长因子-1(IGF-1)和胰岛素因子结合蛋白-3(IGFBP-3)水平的正常参考值,并探讨其与年龄、性别、发育阶段及体质指数的关系。方法选取了大庆市、北京市、上海市不同中小学校的837名体检正常的儿童、青少年(男416名,女421名),由内分泌医师记录其发育状况。用化学发光法(IMMULITE1000)测定血清IGF-1和IGFBP-3。用t检验和线性回归方法研究IGF-1及IGFBP-3与年龄、性别、发育阶段及体质指数(BMI)的关系。结果男孩血清IGF-1于13岁组时出现峰值,女孩11岁组出现峰值;男孩血清IGFBP-3值14岁组时达到峰值,女孩11岁组达到峰值;高峰值出现后,IGF-1和IGFBP-3水平随年龄增长缓慢下降或维持高峰值在平台期;同年龄组相比,男孩血清IGF-1值高于女孩,女孩的IGFBP-3值高于男孩。发育阶段对血清IGF-1水平的影响大于对IGFBP-3的影响,而BMI对血清IGF-1及IGFBP-3水平无明显影响。结论建立了与年龄、性别、发育阶段相关的儿童青少年血清IGF-1及IGFBP-3水平的正常参考值,这些数据对于生长监测、临床诊断及GH治疗后随访有重要参考价值。

Objective To establish the reference values of serum insulin-like growth factor-1 （IGF-1） and insulin-like growth factor binding protein IGFBP-3 （IGFBP-3） in Chinese children aged between 6 and 18 years, and explore the association of serum IGF-1 and IGFBP-3 with age, sex, pubertal stage and BMI. Methods A total of 837 healthy children （aged from 6 and 18 years, 416 boys and 421 girls） from different primary schools and middle schools in Daqing, Beijing and Shanghai, China were recruited in the study. All subjects had their heights and weights measured, and were classified into five stages by endocrinologists using Tanner stage criteria. The levels of serum IGF-1 and IGFBP-3 were assayed by chemiluminescent assay system （IMMULITE 1000）. Non-parametric Mann-Whitney-U test and linear regression analysis were used to analyze the association of serum IGF-1, IGFBP3 with age, sex, pubertal stages and BMI. Results Serum IGF1 peaked around 13 years old and 11 years old in boys and girls, respectively. Similarly, IGFBP-3 reached peak level around 14 years old and Ⅱ years old in boys and in girls, respectively. After attaining the peak levels, serum IGF-1 and IGFBP-3 decreased slightly or stayed at peak levels with age. Serum IGF-1 level tended to be higher in boys compared to girls, while serum IGFBP-3 level was higher in girls than that in boys in the same age. The pubertal development had stronger impact on serum IGF-1 than serum IGFBP-3. Removal of the confounding effects of age and puberty stage, BMI had no statistical significant effect on serum IGF-1 and IGFBP-3 in either gender. Conclusions This study identified age-, sex-, pubertal stage-specific reference levels of serum IGF-1 and IGFBP-3 in Chinese children. These normative data should facilitate growth monitoring, clinical diagnosis, and follow-up of growth hormone treatment.