生长发育迟缓与胰岛素样生长因子的关系

Relationship between growth retardation and insulin-like growth factors

目的提高由于生长激素－胰岛素样生长因子（ＧＨ－ＩＧＦ）轴异常引起的生长发育迟缓诊断的准确性。方法分别收集门诊６８例生长发育迟缓儿童运动激发试验前后２次血清和１４例住院患儿药物激发试验１０次血标本，用免疫放射计量（ＩＲＭＡ）方法测定ＩＧＦ－１，ＩＧＦ－２和ＩＧＦＢＰ－３，放免方法（ＲＩＡ）测定ＧＨ。结果药物激发试验ＧＨ水平与ＩＧＦ－１，ＩＧＦ－２和ＩＧＦＢＰ－３测定一致。运动激发试验根据运动后ＧＨ水平及身高百分位的情况将６８例分为３组：ＧＨ＜５０μｇ／Ｌ，５０～１００μｇ／Ｌ，＞１００μｇ／Ｌ。ＧＨ＜５０μｇ／Ｌ组１４例，其中１０例身高小于第３百分位，其ＩＧＦ－１，ＩＧＦ－２和ＩＧＦＢＰ－３水平分别是（３９±２０），（２７４±１２２），（４２０±２１０）ｎｍｏｌ／Ｌ，低于正常值（Ｐ＜００１），ＧＨ水平与ＩＧＦ－１，ＩＧＦ－２和ＩＧＦＢＰ－３相符。结论用运动激发试验联合测定ＧＨ、ＩＧＦ－１和ＩＧＦＢＰ－３三项指标可以提高由于ＧＨ－ＩＧＦ轴异常所引起的生长发育迟缓诊断的准确性。

Objective To improve the diagnostic accuracy of growth retardation caused by disorders of GH-IGF axis.Methods The serum of 68 outpatients with short stature were collected before and after exercise-exciting tests and the serum of 14 inpatients with the same disease were collected ten times for drug-exciting tests respectively.Then, the IGF-1, IGF-2 and IGFBP-3 level were determined by immunoradiometric assay(IRMA), and GH by radioimmunoassay(RIA).Results In drug-exciting tests, the level of GH coincided with that of IGF-1, IGF-2, IGFBP-3.According to the GH level and height percentile, 68 outpatients were divided into three groups:GH<5 0μg/L, 5 0～ 10 0μg/L , >10 0μg/L.The GH level of 14 patients were below 5 0μg/L; the height of ten of them were below 3rd percentile ; the levels of IGF-1, IGF-2 and IGFBP-3 were (3 9±2 0), (27 4±12 2), (42 0±21 0)nmol/L, respectively, which were much lower than the normal(P<0 001).The level of GH coincided with that of IGF-1, IGF-2 , IGFBP-3.Conclusion Determination of growth hormone together with that of IGF-1 and IGFBP-3 can be used to improve the diagnostic accuracy of growth retardation caused by disorders of GH-IGF axis.