生长激素/胰岛素样生长因子-1轴与脑瘫儿童认知、大运动功能的关系

Relationship of GH/IGF-1 axis with gross motor and cognitive development in cerebral palsy toddlers

目的评估GH/IGF-1轴与幼龄脑瘫儿童粗大运动功能与认知发育的关系。方法纳入2012年1月至2014年12月新桥医院儿科住院的1-4岁脑瘫儿童71例作为脑瘫组,按体格发育落后与否划分为脑瘫伴发育迟滞组（cerebral palsy with retardation,CP-R）50例及脑瘫发育正常组（cerebral palsy with normal growth,CP-N）21例;按粗大运动功能分类系统（gross motor function classification system,GMFCS）划分为Ⅰ-Ⅱ级组20例（CP-GMFCSⅠ-Ⅱ）,Ⅲ-Ⅴ级组51例（CP-GMFCSⅢ-Ⅴ）;按Bayley评分划分智力发育指数（mental development index,MDI）≥70组15例（CP-MDI≥70）,MDI〈70组56例（CP-MDI〈70）。健康对照组为同期体检的健康儿童15例。观察上述儿童的血浆GH基础值及激发值、胰岛素样生长因子-1（insulin-like growth factorⅠ,IGF-1）、类胰岛素生长因子结合蛋白3（insulin-like growth factor-binding protein 3,IGFBP-3）水平作对照研究。结果 1CP-R组较CP-N组GH峰值显著降低,上述2组均较健康对照组GH峰值和IGF-1值显著降低（P〈0.05）。2CP-GMFCSⅠ-Ⅱ组和CP-GMFCSⅢ-Ⅴ组较健康对照组GH峰值和IGF-1值显著降低,CP-GMFCSⅢ-Ⅴ组较CPGMFCSⅠ-Ⅱ组GH峰值和IGF-1值显著降低（P〈0.05）。3CP-MDI〈70组和CP-MDI≥70组较健康对照组GH峰值显著降低（P〈0.05）;CP-MDI〈70组较CP-MDI≥70组和健康对照组IGF-1值显著降低（P〈0.05）。结论脑瘫伴体格发育迟缓、重度粗大运动功能障碍及明显MDI指数落后的儿童存在GH/IGF-1轴受损,提示GH、IGF-1低下可能是脑瘫儿童运动伴认知水平低下的原因之一。

Objective To evaluate the relationship of the growth hormone/insulin-like growth factor-l（ GH/IGF-1） axis with gross motor and cognitive development in cerebral palsy（ CP） toddlers. Methods A total of 86 toddlers,who suffered from CP（ n = 71） or were normal（ n = 15） from 1 to 4 years old,were divided into control group and CP group. The CP group was further divided into CP with retardation group（ CP-R group,n = 50） and CP with normal growth group（ CP-N group,n = 21 toddlers）. According to the gross motor function classification system（ GMFCS）,the CP group were also designated into CP-GMFCSⅠ-Ⅱ group（ n = 20） and CP-GMFCS Ⅲ - Ⅴ group（ n = 51）. According to Bayley scores,the CP was designated into mental development index（ MDI） ≥70 group（ CP-MDI≥70 group,n = 15） and MDI〈 70 group（ CP-MDI〈 70 group,n = 56）. The base value and peak value of plasma GH,and the levels of IGF-1 and insulin-like growth factor-binding protein 3（ IGFBP-3） were analyzed. Results The GH peak value of CP-R group was lower than that of CPN group,and both GH peak value and IGF-1 level of the 2 groups were lower than those of the control group（ P〈0. 05）. CP-GMFCS Ⅰ - Ⅱ group and CP-GMFCS Ⅲ - Ⅴ group showed lower GH peak value and IGF-1 level than the control group,and CP-GMFCS Ⅲ - Ⅴ group showed lower GH peak value and IGF-1 level than CP-GMFCS Ⅰ - Ⅱ group（ P〈0. 05）. CP-MDI〈 70 group and CP-MDI≥70 group showed lower GH peak value than control group（ P〈0. 05）,and CP-MDI〈 70 group showed lower IGF-1 level than CP-MDI≥70 group and control group（ P〈0. 05）. Conclusion The GH/IGF-1 axis damage exists in the toddlers with CP with retardation,gross motor function disorder and obviously low MDI,which predicts that low GH and IGF-1 levels may be one of the factors causing laggardly motor and cognition in CP toddlers.