IGF-1、IGF-2、IGFBP-3与非糖尿病孕妇巨大儿发生的相关性研究

The relationship of macrosomia and insulin-like growth factor-Ⅰ (IGF-Ⅰ), insulin-like growth factor-Ⅱ (IGF-2), IGF binding protein-3 (IGFBP-3)

目的探讨胰岛素样生长因子1、2(IGF-1、IGF-2)、胰岛素样生长因子结合蛋白3(IGFBP-3)与非糖尿病孕妇巨大儿发生的关联性。方法选择2010年1月至2011年5月于上海市浦东新区人民医院产前检查并分娩的初产妇,孕期纵向观察,抽取妊娠中期(26～28周)和妊娠足月(38～41周)的母血及孕妇分娩时新生儿出生体重≥4000g30例(巨大儿组)、2500～3500g30例(正常组)的脐血,应用放射免疫法检测IGF-1、IGF-2、IGFBP-3的水平,并进行对比分析。结果①两组孕妇妊娠足月IGF-1水平均高于妊娠中期,差异有高度统计学意义(分别为P<0.0001、P<0.001),但妊娠中期和足月时,巨大儿组与正常组二组间比较差异均无统计学意义(P>0.05)。巨大儿组脐血IGF-1水平高于正常组,差异有高度统计学意义(P<0.0001);②孕妇血清IGF-2水平巨大儿组与正常组比较差异无统计学意义(P>0.05);③孕妇妊娠中期、妊娠足月血清IG-FBP-3水平巨大儿组明显高于正常组,差异有高度统计学意义(分别为P<0.001、P<0.01);④母血IGFBP-3水平、脐血IGF-1水平与新生儿出生体重正相关。结论 IGF-1参与了胎儿生长发育的调节;胎儿自身循环中的IGF-1与新生儿出生体重有关;非糖尿病孕妇血清IGFBP-3水平与巨大儿形成有关。

Objective To explore the relationship between fetal macrosomia of non- diabetic pregnancy （MNDP） and insulin- like growth factor - I （IGF- D, insulin- like growth factor- II （IGF- 2）, IGF binding pro- tein- 3 （IGFBP- 3）. Methods This was a prospective, observational study of primipara who were prenatal cared and labored in People＇s hospital of Pudong new area. Maternal venous serum samples were collected in week 26~28 and week 38 - 41 while the umbilical cord blood serums were collected after delivery. Levels of IGF - I, IGF - II and IGFBP3 were measured in macrosomia group （birth weight≥4 000 g） and control group （birth weight 2 500-3 500 g） by enzyme linked immunosorbent assay. Results ① The level of IGF - 1 in maternal serum was increased follow- ing the pregnancy extended and was higher in full- term pregnancy, but had no significantly difference between the two groups （P〉0.05）. While in cord blood, level of IGF- 1 of macrosomia group was higher than that of control group （P〈0. 000 1）. ② There was no statistical difference of IGF - 2 level in thaternal serum between the two groups （P〉0. 05）. ③ The levels of IGFBP3 of macrosomia group in full - term pregnancy and mid - pregnancy were significantly higher than that of control group （P〈0. 001, P〈0. 01）. ④ The level of IGFBP - 3 in maternal blood and IGF- 1 in cord blood were positive corretorted with the newborn＇s weight. Conclusions IGF- 1 involved in the fetal growth and development Concentration of IGF - 1 in fetal circulation may close related to newborn＇s weight. High level of IGFBP3 may be one of the cause of macrosomia in non- diabetic pregnancy.