阻塞性黄疸患者生长激素/生长激素结合蛋白检测的临床意义

Clinical significances of growth hormone and growth hormone binding protein determination in patients with obstructive jaundice

目的 探讨阻塞性黄疸患者生长激素 /生长激素结合蛋白变化及其临床意义。方法 对本院 1 999年 8月至 2 0 0 0年 1 0月期间 6 0例男性阻塞性黄疸住院患者 (黄疸组 )术前 1d ,术后 1、3、7d的血清生长激素、生长激素结合蛋白、胰岛素样生长因子 Ⅰ、内毒素、肝功能及前白蛋白水平进行检测 ,并与同期住院的 40例男性单纯性胆囊结石患者 (对照组 )进行比较。结果 生长激素、生长激素结合蛋白、胰岛素样生长因子 Ⅰ在黄疸组较对照组显著降低 (P <0 .0 1 ) ,并与黄疸程度、内毒素水平、前白蛋白相关 (P <0 .0 1 )。结论 阻塞性黄疸患者生长激素 /生长激素结合蛋白轴存在明显下调 ,其原因可能与营养障碍、内毒素血症引起的生长激素受体表达受抑有关 ,并可进一步加重营养障碍和内毒素血症 。

Objective To evaluate the changes and clinical significances of serum growth hormore (GH) and GH binding protein (GHBP) in patients with obstructive jaundice (OJ). Methods Serum levels of GH, GHBP, insulin like growth factor Ⅰ (IGF Ⅰ), endotoxin, prealbumin concentration and liver function in 60 male in patients with OJ were detected 1 d preoperatively and 1, 3, 7 d postoperatively. And 40 male patients with simple gallbladder stone hospitalized in the same period were served as control. Results The levels of GH, GHBP and IGF Ⅰ were significantly lower in patients with obstructive jaundice than in control group( P <0.01), which was correlated with the levels of bilirubin, endotoxin and prealbumin ( P <0.01). Conclusion The obviously downregulation of GH/GHBP axis in patients with OJ probably results from the inbibition of expression of GH receptor due to nutritional dysfunction and endotoxemia, and further aggravate the nutritional dysfuction and endoxemia, which may be one of the important factors in the pathophysiological changes of OJ.