慢性乙肝患者生长激素-胰岛素样生长因子轴的变化及其临床意义

CHANGE OF GROWTH HORMONE AND INSULIN-LIKE GROWTH FACTORS AXIS AND CLINICAL SIGNIFICANCE IN CHRONIC VIRUS B HEPATITIS AND CIRRHOSIS

目的探讨慢性乙型肝炎（慢性乙肝）和肝硬化患者生长激素一胰岛素样生长因子轴（growth hormoneinsulin-like growth factor axis，GH-IGF）的变化及其临床意义。方法采用酶联免疫吸附法检测39例慢性乙肝、37例乙肝肝硬化及12例健康献血者血清胰岛素样生长因子1（insulin-like growth factor-1，IGF-1）和胰岛素样生长因子结合蛋白-3（insulin-like growth factor binding protein-3，IGFBP-3），采用RIA法检测血清生长激素（growth hormone，GH）。其中26例肝组织标本行IGF-1的免疫组织化学染色，并采用多媒体彩色图文分析系统进行图像定量分析。结果①慢性乙肝和肝硬化患者血清GH水平较正常对照组显著升高（P〈0.05），而血清IGF-1和IGFBP-3水平明显下降（P〈0．05）；②慢性肝炎组随着炎症活动度的增加血清GH水平升高，血清IGF-1和IGFBP-3水平逐渐降低（P〈0．05），肝硬化组随着肝功能代偿能力的减退血清GH水平升高，血清IGF-1和IGFBP-3水平明显下降（P〈0.05）；③G1～G4组肝组织IGF-1的表达较GO组增加（P〈0.05），但G1～G4组之间无显著性差异（P〉0．05）。结论慢性乙肝和肝硬化患者GH-IGF轴发生显著性变化，存在GH抵抗现象。血清GH、IGF-1、IGFBP-3水平在一定程度上反映肝细胞的炎症坏死程度及肝脏合成储备功能。

Objective To study the change and clinical significance of growth hormone and insulin-like growt.h factors axis（GH-IGF） in chronic hepatitis B and cirrhosis. Methods Enzyme linked immunoadsorbent assay method was used to examine the serum insulin-like growth factor-1（IGF-1） and insulin-like growth factor binding protein-3（IGFBP-3） level in 39 chronic hepatitis B,37 cirrhosis patients and 12 healthy blood donors. RIA method was used to examine serum growth hormone（GH） level. The expression of IGF-1 was studied by immunohistochemistry and quantitatively evaluated with image analysis system in 26 hepatic tissues. Results ①Compared to the normal control group, serum GH level has increased notably in the chronic hepatitis B and cirrhosis patients（ P 〈0.05） ,however,serum levels of IGF-1 and IGFBP-3 level have an obvious decrease in these patients （P 〈 0.05）. ②Serum GH level was increased as the increase of inflammation activity in the chronic hepatitis group, while the serum IGF-1 and IGFBP-3 level decreased gradually（ P 〈0.05）. The serum IGF-1 and IGFBP-3 level decreased obviously as the decrease of liver functional compensation ability in the cirrhosis group（ P〈0.05）. ③Compared to the normal control group,the expression of hepatic tissues IGF-1 was increased from G1 to G4（ P〈0.05）. Conclusion There is GH resistant in chronic virus B hepatitis and cirrhosis. The levels of serum GH, IGF-1 and IGFBP-3 and the expression of hepatic tissue IGF-1 can reflect the degree of hepatocyte inflammation necrosis and liver synthetic reserve function.