2～7岁小于胎龄儿血Ghrelin、胰岛素样生长因子-1和胰岛素样生长因子结合蛋白-3的水平及其意义

Levels of plasma Ghrelin,IGF-1,IGFBP-3 in 2-7 years old children with small for gestational age and significances

目的:探讨Ghrelin与生长激素-胰岛素样生长因子(GH-IGF)轴的关系,以及对小于胎龄儿(SGA)生后生长发育的影响。方法:选择新生儿期足月小于胎龄、现年龄为2～7岁儿童30例作为SGA组,根据有无追赶生长(CUG)分为SGA-CUG组(19例)和SGA-无CUG组(11例);足月适于胎龄(AGA)的2～7岁矮小儿童20例作为AGA矮小组;同时选择足月适于胎龄的2～7岁正常身高儿童19例作为对照组。计算体质量的标准差计分(SDS)、身高SDS、72h摄入热卡,检测空腹血Ghrelin、胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)和血糖水平并做相关性分析。结果:SGA-CUG组和SGA-无CUG组血浆Ghrelin水平(mg.L-1)(0.371±0.093和0.446±0.076)均高于AGA矮小组及对照组(0.263±0.174和0.245±0.080)(均P<0.05),SGA-无CUG组升高最为显著,SGA-CUG组与SGA-无CUG组比较差异无统计学意义(P>0.05),矮小组与对照组比较差异无统计学意义(P>0.05)。IGF-1和IGFBP-3水平(mg.L-1)在SGA-无CUG组(123.882±46.275和33.310±8.836)和AGA矮小组(171.83±65.77和42.150±13.515)明显低于SGA-CUG组(380.037±137.548和147.389±46.430)和对照组(354.121±95.023和145.058±30.706)(均P<0.05)。SGA-CUG组和对照组相关分析显示Ghrelin与摄入热量、体质量SDS、IGF-1和IGFBP-3均呈负相关关系(SGA-CUG组r=-0.628,P<0.01;r=-0.658,P<0.05;r=-0.854,P<0.000 1;r=-0.685,P<0.001;对照组r=-0.808,P<0.000 1;r=-0.664,P<0.001;r=-0.771,P<0.000 1;r=-0.502,P<0.05);与年龄、身高SDS及血糖无明显相关关系(SGA-CUG组r=0.255,r=-0.218,r=-0.135,均P>0.05;对照组r=0.203,r=-0.328,r=-0.228,均P>0.05)。结论:Ghrelin与GH-IGF轴之间相互作用,共同调控生长发育。SGA可能存在不同程度的Ghrelin抵抗及GH-IGF轴损害,且生后持续存在。

Objective To explore the relationship between Ghrelin and growth hormone（GH）-insulin-like growth factor（IGF）axis and the effect on the growth and development in 2-7 years old children with small for gestational age（SGA）at birth.Methods Thirty 2-7 years old children with SGA at birth were used as SGA group,and according catching up growth（CUG）or not they were divided into SGA-CUG group and SGA-no-CUG group.Twenty short stature children with appropriate for gestational age（AGA）at birth were used as AGA short stature group,and nineteen normal height children with AGA at birth were used as control group.Height and weight were measured and the standard deviation score（SDS）were calculated.The levels of Ghrelin,IGF-1,insulin-like growth factor binding protein-3（IGFBP-3）and blood sugar were measured and compared and the correlation was analyzed in all the subjects.Results The levels of plasma Ghrelin（mg·L-1）in SGA-CUG group and SGA-no-CUG group（0.371±0.093 and 0.446±0.076）were much higher than those in AGA short stature group and control group（0.263±0.174 and 0.245±0.080）（P〈0.05）and highest in SGA-no-CUG group.There were no significant differences between SGA-CUG group and SGA-no-CUG group as well as AGA short stature group and control group（P〉0.05）.The levels of serum IGF-1（mg·L^-1）and IGFBP-3（mg·L^-1）in SGA-no-CUG group（123.882±46.275 and 33.310±8.836） and AGA short stature group（171.83±65.77 and 42.150±13.515） were significantly lower than those in SGA-CUG group（380.037±137.548 and 147.389±46.430）and control group（354.121±95.023 and 145.058±30.706）（P〈0.05）.The correlation analysis in SGA-CUG group and control group showed negative correlation between Ghrelin and calory,weight SDS,IGF-1,IGFBP-3（SGA-CUG group：r=-0.628,P〈0.01;r=-0.658,P〈0.05;r=-0.854,P〈0.000 1;r=-0.685,P〈0.001;control group：r=-0.808,P〈0.000 1;r=-0.664,P〈0.001;r=-0.771,P〈0.000 1;r=-0.502,P〈0.05）.There were no correlation between Ghrelin and year old,height SDS and blood sugar（SGA-CUG group：r=0.255,-0.218,-0.135,all P〉0.05;control group：r=0.203,-0.328,-0.228,all P〉0.05）.Conclusion There is interaction between Ghrelin and GH-IGF axis,and they regulate the growth and development together.There is resistance to Ghrelin and aggression to GH-IGF axis and it will interfere the growth and development untill prepubescence.