不同胎龄及体重新生儿血Ghrelin、胰岛素样生长因子-1、胰岛素样生长因子结合蛋白-3、胰岛素水平检测分析

The concentration of plasma Ghrelin,IGF-1,IGFBP-3 and Insulin in newborn with different gestational age and birth weight

目的:探讨Ghrelin与新生儿胰岛素-胰岛素样生长因子轴的关系,进一步揭示其对新生儿生长发育及能量代谢的影响。方法:选择62例新生儿,按胎龄、体重分为足月儿、早产儿、适于胎龄儿(appropriate for gestational age,AGA)和小于胎龄儿(small for gestational age,SGA)。其中胎龄30～34周14例,34+1～37周14例,37+1～41周34例。足月SGA13例,足月AGA 21例。检测血Ghrelin、胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)、胰岛素样生长因子结合蛋白-3(insulin-like growth factor binding protein-3,IGFBP-3)以及胰岛素、血糖水平,并在各组间进行比较。结果:30～34周、34+1～37周、37+1～41周3组比较Ghrelin浓度分别为(2.238±0.618)ng/ml(、1.226±0.37)ng/ml(、1.036±0.328)ng/ml,早产儿Ghrelin水平明显高于足月儿(P<0.01),且随着胎龄的增大差距减小;IGF-1分别为(43.214±16.723)ng/ml、(115.579±30.136)ng/ml、(153.292±26.633)ng/ml,IGFBP-3分别为(70.814±22.603)ng/ml、(123.300±28.666)ng/ml、(157.214±38.990)ng/ml,胰岛素分别为(1.032±0.812)μU/ml、(5.534±2.273)μU/ml、(14.654±3.064)μU/ml。IGF-1、IGFBP-3、胰岛素水平早产儿明显低于足月儿(P<0.01),足月SGA的Ghrelin水平明显高于AGA(P<0.01),IGF-1、IGFBP-3、胰岛素水平明显低于AGA(P均<0.01)。各组血糖水平无明显差异(P>0.05)。在SGA和AGA组Ghrelin分别与IGF-1、IGFBP-3及胰岛素呈明显负相关(P<0.01)。结论:SGA新生儿存在胰岛素-IGF轴的损害,IGF-1与胰岛素水平低下,从而使Ghrelin浓度反馈性的升高,以代偿其能量代谢的负平衡。

Objective：To explore the relationship between Ghrelin and insulin-IGF axis and the effect to the growth and development and energy metabolism in newborn. Methods：62 newborn were divided into preterm infant,term infant,SGA infant and AGA infant groups according to the gestational age and birth weight.14 cases were 30~34 weeks gestational age,14 cases were 34＋1~37 weeks gestational age,and 34 cases were 37＋1~41 weeks gestational age.In term group,13 cases were SGA infants and 21 cases were AGA infants.The concentration of Ghrelin,IGF-1,IGFBP-3,insulin and glucose were measured and compared and correlation analyzed in all the subjects. Results：The concentration of plasma Ghrelin in 30~34 weeks group,34＋1~37 weeks group and 37＋1~41 weeks group was（2.238±0.618）ng/ml,（1.226±0.37）ng/ml,（1.036±0.328）ng/ml respectively.It was much higher in preterm infant than in the term infant（P〈0.000 1）.Furthermore,the higher the gestational age,the smaller the difference.The concentration of IGF-1 was（43.214±16.723） ng/ml,（115.579±30.136）ng/ml,（153.292±26.633）ng/ml respectively.The concentration of IGFBP-3 was（70.814±22.603）ng/ml,（123.300±28.666）ng/ml,（157.214±38.990）ng/ml respectively.The concentration of insulin was（1.032±0.812）μU/ml,（5.534±2.273）μU/ml,（14.654±3.064）μU/ml respectively.The concentration of IGF-1,IGFBP-3 and insulin in preterm infant were lower than in the term infant（P〈0.0001）.The concentration of plasma Ghrelin in SGA was higher than in AGA in term infant（1.996±0.294（ng/ml） 1.036±0.328（ng/ml））（P〈0.0001）.The concentration of IGF-1,IGFBP-3 and insulin in SGA infant were lower than in AGA infant（IGF-1：68.479±19.489（ng/ml） 153.292±26.633（ng/ml）;IGFBP-3：47.662±17.642（ng/ml） 157.214±38.99（ng/ml）;insulin：3.898±2.289（μU/ml） 14.654±3.064（μU/ml））（P〈0.000 1）.The concentration of glucose were no significant difference in all groups（P〉0.05）.The correlation analysis in SGA group and AGA group showed negative correlation between Ghrelin and IGF-1,IGFBP-3 and insulin（in AGA group r=-0.831 1,P〈0.000 1;r=-0.713,P〈0.001;r=-0.688,P〈0.001;in SGA group r=-0.654,P〈0.05;r=-0.737,P〈0.05;r=-0.964,P〈0.000 1）. Conclusion：There are insulin-IGF axis lesion in SGA infant.The concentration of IGF-1 and insulin are low,that lead to the concentration of Ghrelin increasing,to compensate the negatively balance.