阻塞性睡眠呼吸暂停低通气综合征儿童血清生长因子表达的影响因素分析

Analysis of the influencing factors for serum growth factor in children with obstructive sleep apnea hypopnea syndrome

目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿血清胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平的变化及其影响因素。方法纳入2012年7月-2015年7月在昆明市儿童医院住院的3~6岁220例OSAHS患儿和40例非睡眠呼吸障碍患儿。按呼吸暂停低通气指数(AHI)将OSAHS患儿分为轻度、中度、重度OSAHS组。检测所有儿童血清IGF-1、IGFBP-3水平,体重指数(BMI)、身高及体重,比较各组间的差异,并采用多元逐步回归分析探讨影响患儿血清IGF-1、IGFBP-3水平的因素。结果重度OSAHS组血清IGF-1水平[(121.86±36.47)μg/L]显著低于对照组[(149.44±31.44)μg/L]、轻度OSAHS组[(147.63±26.83)μg/L]和中度OSAHS组[(142.11±34.50)μg/L](P均<0.05),重度OSAHS组身高显著低于对照组(102.64±5.95)cm vs(105.22±6.03)cm,P<0.05)。血清IGFBP-3水平、BMI和体重在各组间差异无统计学意义(P均>0.05)。经多元逐步回归分析结果显示OSAHS组的血清IGF-1、IGFBP-3水平受年龄、平均最低血氧饱和度(LSaO2)的影响。结论 OSAHS患儿生长发育迟缓可能与血清IGF-1水平降低有关,缺氧是影响OSAHS患儿血清IGF-1水平变化的因素。

Objective To investigate the level of serum insulin-like growth factor-1（IGF-1）,insulin-like growth factor binding protein-3（IGFBP-3）and the influencing factors for these two growth factors in children with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods Totally 220 children aged 3 to 6 with OSAHS and 40 children without sleep breathing disorder as controls in Kunming Children′s Hospital were enrolled in this study from July 2012 to July2015.Participants with OSAHS were divided into mild,moderate and severe OSAHS group according to the value of apnea hypopnea index（AHI）obtained from the polysomnography（PSG）.The level of serum IGF-1,IGFBP-3,body mass index（BMI）,height and weight of all children were measured and compared among groups by variance analysis.The influencing factors of serum IGF-1,IGFBP-3 were determined by multiple stepwise regression analysis. Results The level of serum IGF-1 in the severe group was lower than other three groups（sever group vs.control group vs.mild group vs.moderate group：121.86±36.47 vs.149.44±31.44 vs.147.63±26.83 vs.142.11±34.50,all P0.05）.The value of height in the severe group was lower than that in control group（102.64±5.95 cm vs.105.22±6.03 cm,both P0.05）.No significant differences were found in the level of serum IGFBP-3,BMI and weight among groups（all P0.05）.The influencing factors for the level of serum IGF-1,IGFBP-3 in OSAHS children were the age and the lowest oxygen saturation（LSaO2）. Conclusions The growth retardation of children with OSAHS may be related to the reduction of the level of serum IGF-1,while hypoxia is associated with the fluctuation of the serum level of IGF-1 in OSAHS children.