骨钙素、Ⅰ型前胶原羧基端前肽、胰岛素样生长因子-1及其相关激素与胎儿骨发育的关系

Relationships between Osteocalcin,Carboxyterminal Propeptide of Type Ⅰ Procollagen,Insulin-Like Growth Factor-1 and Related Hormones and Fetal Bone Development

目的探讨骨钙素（OC）、Ⅰ型前胶原羧基端前肽（PICP）及胰岛素样生长因子-1（IGF-1）等激素水平与胎儿骨生长发育的关系。方法选择本院2008年10月-2009年10月收治的新生儿80例。男41例,女39例;胎龄28~42周。根据不同出生体质量分为小于胎龄（SGA）儿组22例,适于胎龄（AGA）儿组36例及大于胎龄（LGA）儿组（22例）。胎儿娩出后,胎盘娩出前抽取其脐静脉血6 mL,采用放射免疫分析法测定其血清OC、IGF-1及甲状旁腺激素水平,酶联免疫吸附法检测其脐血PICP水平;同时检测其血钙、磷、ALP水平,测量新生儿生长参数,计算体质量指数（BMI）。结果 1.脐血OC水平在SGA儿组、AGA儿组、LGA儿组间比较差异有统计学意义（P=0.000）,LGA儿组显著高于AGA儿及SAG儿组（P〈0.01,0.001）;脐血OC水平与出生体质量、头围、BMI呈正相关（Pa〈0.05）,与身长无明显相关性（P〉0.05）。2.LGA儿组脐血IGF-1水平显著高于AGA儿及SAG儿组,3组间比较有统计学差异（P=0.002）;脐血IGF-1水平与出生体质量、头围、BMI水平均呈正相关（Pa〈0.05）,与身长无明显相关性（P〉0.05）。3.AGA儿组、LGA儿组脐血PICP水平明显高于SGA儿组,但3组间无统计学差异（P=0.070）。脐血PICP、PTH水平与生长参数各指标水平均无直线相关关系（Pa〉0.05）,偏相关分析脐血PICP与出生体质量、头围、BMI均呈正相关（r=0.239、0.250、0.306,Pa〈0.05）。4.脐血OC水平与PICP、IGF-1水平均呈正相关（Pa〈0.05）,OC、PICP与PTH、ALP水平之间均无明显相关（Pa〉0.05）。5.3组脐血钙、血磷、ALP水平均无统计学差异（Pa〉0.05）。结论 SGA儿低血清OC、PICP水平与骨形成活动下降相关,脐血OC、PICP及IGF-1可作为评价胎儿骨骼生长发育的临床指标之一。

Objective To explore the relation and interaction of osteocalcin（OC）,carboxyterminal propeptide of type I procollagen（PICP）,insulin-like growth factor-1（IGF-1）,related hormones and the fetal bone development.Methods Eighty cases of newborns（41 boys and 39 girls） at the Third Affiliated Hospital of Inner Mongolia Medical College from Oct.2008 to Oct.2009 were selected,their gestational age were 28-42 weeks.Depending on birth weight the infants were divided into small for gestational age（SGA） group（22 cases）,appropriate for gestational age（AGA） group（36 cases）,and large for gestational age（LGA） group（22 cases）.Their umbilical cord blood（6 mL） was collected immediately after their delivery,the levels of serum OC,IGF-1 and parathyroid hormone were measured by radioimmunoassay,and the levels of PICP of cord blood were determined by the enzyme linked immunosorbent assay;meanwhile their blood calcium,phosphorus,ALP level,neonate growth parameters,and body mass index（BMI） were also evaluated.Results 1.Umbilical cord blood OC levels of 3 groups were significantly different（P=0.000）.The OC level in LGA group was significantly higher than those in AGA group and SGA group（P0.01,0.001）;their cord blood OC level and birth weight,head circumference,BMI were positively correlated（Pa0.05）.No significant correlation was found in the height of the infants（P0.05）.2.In LGA group,the level of IGF-1 of cord blood was significantly higher than those in AGA group and SGA group,and there was significant difference among 3 groups（P=0.002）;there was a positive correlation as for the cord blood IGF-1 level and birth weight,head circumference and BMI levels（Pa0.05）,and there was no significant correlation as for the height of the infants（P0.05）.3.The fetal cord blood PICP level in AGA group and LGA group was significantly higher than that in SGA group,but there was no significant difference among 3 groups（P=0.070）.As for the PTH level of umbilical cord blood,there was no significant difference among 3 groups（P0.05）;there was no significantly linear correlation between the cord blood PICP,PTH levels and the level of growth parameters of each index（P0.05）.Partial correlation analysis indicated that there were positive correlations between PICP level of umbilical cord blood and birth weight,head circumference and BMI（r=0.239,0.250,0.306,Pa0.05）.4.There were positive correlation between the level of cord blood OC and PICP,IGF-1 level（Pa0.05）,but there was no correlation between OC,PICP and PTH,ALP levels（Pa0.05）.5.There was no significant difference in Ca level,phosphorus level and ALP level of the blood among 3 groups（Pa0.05）.Conclusions There is a correlation between the low serum OC,PICP level and the activity decrease of bone formation in SGA infants.Cord blood OC,PICP and IGF-1 can be used as one of clinical indicators for the fetal bone development.