儿童肾病综合征和慢性肾功能衰竭的胰岛素样生长因子及其结合蛋白

A STUDY ON INSULIN-LIKE GROWTH FACTOR-Ⅰ AND ITS BINDING PROTEINS OF CHILDREN WITH NEPHROTIC SYNDROME AND CHRONIC RENAL FAILURE

目的 :了解肾病综合征 (NS)和慢性肾功能衰竭 (CRF)患儿的胰岛素样生长因子 Ⅰ (IGF Ⅰ )及其结合蛋白 (IGFBPs)改变的机制。方法 :采用免疫放射法和放射免疫法测定了 2 4例特发性NS (活动期和恢复期各 1 2例 )及 6例CRF患儿的血清IGF Ⅰ和IGF BPs。结果 :NS组活动期及CRF组透析前的血清IGF Ⅰ均显著低于对照组 (P <0 0 1 ) ,而IGFBP 2均显著高于对照组 (P <0 0 1 )。与对照组相比 ,NS组活动期IGFBP 3显著降低(P <0 0 1 ) ,而CRF组血液透析前IGFBP 3显著升高 (P <0 0 5) ;NS组活动期IGFBP 1显著高于对照组 (P <0 0 1 ) ,而CRF组血液透析前的改变无统计学差异。NS恢复期的IGF Ⅰ、IGFBPs与活动期相比 ,差异显著 (P <0 0 1 )。结论 :NS、CRF患儿的IGF Ⅰ的降低 ,但IGFBPs的改变各不相同 ,提示IGF Ⅰ的降低是导致生长障碍的共有因素 ;IGF BPs的改变的不同 ,不仅与肾功能和营养因素有关 ,而且与肾脏疾病有关。

Objective:To investigate the correlation between insulin-like growth factor-Ⅰ(IGF-Ⅰ),IGF binding proteins(IGFBPs) and growth retardation in nephrotic syndrome (NS)and chronic renal failure(CRF).Methods:The serum IGF-Ⅰ and IGFBPs level measured by using radioimmunoassay or immunoradiometric assay in children with NS,active state group without treatment(NS=12) and on remission with steroid treatment(RENS=12),CRF before and after hemodialysis(CRF=6) and normal control(NC=10).Results:Serum level of IGF-Ⅰ decreased and IGFBP-2 increased significantly( P <0 01) in NS and CRF than that in NC.Serum level of IGFBP-3 was lower in NS,but higher in CRF,than NC( P <0 01);IGFBP-1 was higher( P <0 01) in NS,but this change in CRF was not significant;Serum level of IGF-Ⅰ and IGFBPs have no significance in NS than RENS groups.Conclusion:The lower serum level of IGF-Ⅰ in children with NS and CRF play a role in the growth retardation.The changes of IGFBPs of NS and CRF might not only be related to the renal function and nutrition,but also to the underlying renal disease.