肝硬化患者胰岛素抵抗与血清生长激素、胰岛素样生长因子Ⅰ轴的研究

The Research of Insulin Resistance in Connection with the Serum Levels of Growth Hormone and Insulin-like Growth FactorⅠin Liver Cirrhosis Patients

目的：研究肝硬化(LC)患者胰岛素抵抗指数(HOMA-IRI)、生长激素(GH)和胰岛素样生长因子I(IGF-I)水平的变化,探讨肝硬化发病中胰岛素抵抗(IR)、GH/IGF-I轴的作用以及时预后的影响。方法：测定住院人群中LC组和对照组空腹血糖(FBG)、空腹血清胰岛素(FINS),采用稳态模型法计算HOMA-IRI,同时检测GH和IGF-I水平。结果：①LC组FINS、IRI和血清GH水平显著高于对照组,IGF-Ⅰ水平显著低于对照组(P＜0.05)；②按Child-Pugh分级,肝硬化C级的FINS、IRI和GH水平显著高于肝硬化A、B级,IGF-Ⅰ显著低于肝硬化A、B级(P＜0.05)；肝硬化B级IRI、GH水平显著高于肝硬化A级,IGF-Ⅰ显著低于肝硬化A级(P＜0.05)；③肝炎后肝硬化组FINS、IRI和GH水平显著高于酒精性肝硬化组,IGF-Ⅰ水平显著低于酒精性肝硬化组(P＜0.05)；④肝硬化患者Child-Pugh积分与FINS、IRI、GH水平呈正相关(r=0. 2772,P＜0.01；r=0.1853,P＜0.05；r=0.3231,P＜0.01),但与IGF-Ⅰ水平呈负相关(r=0.2487,P＜0.05)；IRI与GH水平呈正相关(r=0.2582,P＜0.01),与IGF-Ⅰ水平呈负相关(r=-0.1948,P＜0.05)。结论：肝硬化患者存在着胰岛素抵抗和GH/IG-Ⅰ轴异常,胰岛素抵抗和GH/IG-Ⅰ轴异常可能参与了肝硬化的病情进展并和肝功能损害程度直接相关；检测肝硬化患者血清FINS、IRI、GH和IGF-Ⅰ水平,可以作为判断肝功能分级和预后的重要指标。

Objective：To investigate the scale of insulin resistance index of homeostasis model assessment （HOMA-IRI） and serum concentrations of growth hormone（GH） and insulin-like growth factor Ⅰ（IGF-Ⅰ） in liver cirrhosis（LC）patients and evaluate their effects on the cause and prognosis of LC. Methods：The radioimmunoassay（RIA） was used to measure the fasting ser um levels of insulin（FINS）, GH and IGF Ⅰ among 52 LC patients and 41 controls. HOMA-IRI was calculated. Results：The levels of FINS,HOMA-IRI and GH significantly increased in LC patients in contrast to those of the controls,but the level of IGF-Ⅰdecreased. During the course of LC progression, the levels of FINS, HOMA-IRIand GH increased,however the level of IGF-Ⅰ decreased. The levels of FINS , HOMA-IRI, and GH significantly increased in post-hepatitis LC patients,compared with the alcoholic LC patients, but the level of IGF-Ⅰ decreased. There was positive correlation between Child-Pugh score and the levels of FINS, HOMA-IRI and GH,but negative correlation was evident between Child-Pugh score and IGF-Ⅰ IRI was found to be positively related with serum level of GH and negatively related with serum level of IGF-Ⅰ. Conclusion： Insulin resistance and the disorder of GH/IGF-I axis exist in LC patients and maybe play a direct effect on the cause and progression of LC. Furthermore, the levels of FINS, IRI,GH andIGF-Ⅰ may be considered as important signs to evaluate liver function and LC prognosis.