原发性肾病综合征患者血清胰岛素样生长因子1的变化及其与骨代谢的关系

Change of serum insulin-like growth factor-1 in primary nephrotic syndrome patients and its relationship with bone metabolism

目的 探讨原发性肾病综合征（PNS）患者血清胰岛素样生长因子1（IGF-1）的变化及其与骨代谢指标之间的关系.评价IGF-1在PNS患者骨代谢异常机制中的临床价值.方法 随机选取2008年1月至2009年5月临床资料完整的慢性肾脏病（CKD）1、2期PNS患者30例为对象;健康体检者61例为健康对照组.测定血清IGF-1、钙、磷、PTH、25羟基维生素D3[25-（OH）D3]骨钙素（BGP）、Ⅰ型胶原吡啶交联C终端肽（CTx）及尿钙/尿肌酐（Uca/Cr）.双能X线骨密度仪枪测患者骨密度（BMD）. 结果与健康埘照组比较,PNS组血Ca、25-（OH）D3及BGP水平显著降低;血CTx水平及Uca/Cr比值显著增高（均P〈0.05）;BMD水平降低[（1.078±0.090）g/cm2比（1.090±0.062）g/cm2,P〉0.05],但差异无统计学意义.PNS组血清IGF-1水平显著低于健康对照组,差异有统计学意义[（155.75±17.48）μg/L比（223.17±16.44）μ/L,P〈0.051,且与24 h尿蛋门量及CTx呈负相关（r=-0.757和r=-0.786,均P〈0.05）;与血BGP和BMD呈正相关（r=0.861和r=0.584,均P〈0.05）.结论 PNS患者（CKD 1、2期）存在骨代谢异常,表现为骨形成减少、骨吸收增加.血清IGF-1与血BGP、CTx及BMD相关,可作为反映PNS患者骨代谢改变的临床指标之一.

Objective To study the change of serum insulin-like growth factor 1（IGF-1）in primary nephrotic syndrome（PNS）patients and its relationship with bone metabolism, and to investigate the clinical significance of IGF-1 in the mechanism of bone metabolic disorders in PNS patients. Methods A total of 30 PNS patients with chronic kidney disease（CKD）stage 1 and 2 were randomly selected from 2008.1 to 2009.5 in our hospital. Serum IGF-1, albumin, calcium, phosphorus, PTH,25 hydroxy vitamin D3, bone gla protein（BGP）, degradation products of C-terminal telopeptides of type I collagen（CTx）, 24-hour urinary protein excretion, and ratio of urinary calcium to creatinine（UCa/Cr）were measured. Healthy control group of 61 persons were randomly selected from our medical examination center at the same time. Results Serum levels of calcium, 25 hydroxy vitamin D3 and BGP were significantly lower;CTx and UCa/Cr were significantly higher in PNS patients（P〈0.05）as compared to healthy control group. BMD of PNS patients was lower but without significant difference compared with healthy control group[（1.078± 0.090）g/cm2 vs（1.090±0.062）g/cm2, P〉0.05]. Serum level of IGF-1 was significantly lower in PNS patients and was positively correlated with BMD and BGP,and negatively correlated with 24-hour urinary protein excretion and CTx. Conclusions Bone metabolic disorder exists in PNS patients with the appearance of decreased bone formation and increased bone absorption.Serum level of IGF-1 has good correlations with bone biochemical markers.which may be used as a new bone biochemical marker of bone metabolism in kidney disease.