血清生长激素和胰岛素样生长因子-Ⅰ在危重症中的变化及临床意义

The variation and clinical significance of growth hormone and insulin like growth factor-Ⅰ in children with critical disease

目的 探讨血清生长激素（growth hormone,GH）和胰岛素样生长因子-Ⅰ （insulin like growth factor-Ⅰ,IGF-Ⅰ）在危重症患儿中的变化及其临床意义.方法 选择2009年1月至2012年1月同期入住PICU的脓毒症患儿42例为脓毒症组,先天性心脏病择期在体外循环下行开胸手术治疗后的患儿20例为术后组,检测入院次日及手术后次日晨血清GH和IGF-Ⅰ水平,选择健康体检儿童60例为对照组,比较组间GH、IGF-Ⅰ水平的变化.结果 脓毒症组GH水平为（6.71±6.62） ng/ml,术后组GH水平为（8.86±8.06） ng/ml,,两者均显著高于对照组（3.87±3.31） ng/ml,差异有统计学意义（P＜0.05）,而脓毒症组与术后组之间差异无统计学意义;脓毒症组IGF-Ⅰ水平为（63.72±54.17） ng/ml,与术后组（119.06±102.12） ng/ml和健康对照组（154.22±107.10） ng/ml比较,显著降低,差异有统计学意义（P＜0.05）,术后组与对照组比较差异无统计学意义;脓毒症组内存活者与死亡者比较GH无统计学意义差异,IGF-Ⅰ水平显著降低（P＜0.05）.结论 危重症时GH水平升高对机体应激具有积极作用;脓毒症时IGF-Ⅰ水平显著降低,可作为反映重症感染存在的较灵敏指标,并有助于判断预后.

Objective To explore the variation and clinical significance of growth hormone（GH） and insulin like growth factor-Ⅰ（IGF-Ⅰ） in children with critical disease.Methods One hundred and twenty-two cases were recruited into the study,among which 42 cases were sepsis in paediatric intensive care unit （sepsis group）,20 cases had finished the cardiopulmonary bypass surgery without infection （surgery group）.Sixty healthy children served as control group.Serum levels of GH and IGF-Ⅰ were deteced with immunochemiluminometric assay.Results The serum levels of GH were （6.71 ± 6.62） ng/ml in sepsis group,（8.86 ±8.06） ng/ml in surgery group,（3.87 ± 3.31） ng/ml in control group.Compared with the control group,the serum levels of GH in sepsis group and surgery group were increased significantly （P ＜ 0.05）.There was no significant difference between sepsis group and surgery group.The serum IGF-Ⅰ levels were （63.72 ±54.17） ng/ml in sepsis group,（119.06 ± 102.12） ng/ml in surgery group and（154.22 ± 107.10） ng/ml in control group separately.The serum IGF-Ⅰ level of sepsis group was significantly decreased compared to the other two groups （P ＜ 0.05）.There was no significant difference between surgery group and control group （P ＞0.05）.In sepsis group,compared with those who died,the GH of the survival showed no significant difference,IGF-Ⅰ was significantly increased.（P ＜ 0.05）.Conclusion GH playes a positive effect in patients with critical disease.IGF-Ⅰ decreases greatly in patients with serious infection.It suggests that IGF-Ⅰ could be a sensitive marker for reflecting whether there is serious infection.The sharply decreasing of IGF-Ⅰ may predict a bad outcome.