生长激素-胰岛素样生长因子轴功能检测在矮小症儿童病因诊断中的意义

Significance of growth hormone-insulin-like growth factor axis function in the diagnosis of children with dwarfism

目的探究生长激素(GH)-胰岛素样生长因子(IGF)轴功能检测在矮小症儿童病因诊断中的意义。方法回顾性选取2015年6月至2017年6月在江苏省淮安市第二人民医院接受治疗的100例矮小症患儿作为研究对象,所有患儿均实施精氨酸激发试验与可乐定激发试验,对患儿GH水平、IGF-1水平以及胰岛素样生长因子结合蛋白-3(IGFBP-3)水平进行测定,依据检测结果对矮小症予以病因分类。结果100例矮小症患儿中,生长激素缺乏症(GHD)16例(16.0%),疑似GH不敏感综合征(GHIS)2例(2.0%),疑似GHD 14例(14.0%),特发性矮小症(ISS)68例(68.0%)。GHD、疑似GHIS、疑似GHD、ISS矮小症儿童GH水平逐渐升高(P<0.05);疑似GHD、ISS矮小症儿童IGF-1水平均显著高于GHD、疑似GHIS矮小症儿童(P<0.05),IGFBP-3水平均显著高于GHD、疑似GHIS矮小症儿童(P<0.05),而疑似GHIS矮小症儿童IGF-1水平又显著高于GHD矮小症儿童(P<0.05),但二者的IGFBP-3水平之间的差异无显著性(P>0.05),疑似GHD、ISS矮小症儿童IGF-1、IGFBP-3水平之间的差异均无显著性(P>0.05)。结论矮小症儿童多以ISS居多,给予患儿GH-IGF轴功能检测,能够帮助明确病因,为临床治疗提供依据。

Objective To explore the significance of growth hormone(GH)-insulin-like growth factor(IGF)axis function in the diagnosis of children with dwarfism.Methods 100 cases of children with dwarfism from June 2015 to June 2017 in Huai'an Second People's Hospital of Jiangsu Province for treatment were retrospectively selected as the research objects,all children performed the implementation of arginine stimulating test and clonidine provocation tests.GH level,level of IGF 1 and IGF binding protein 3(IGFBP 3)levels were determined,based on the test results of dwarfism etiology classification.Results Among 100 cases of dwarfism children,there were 16 cases(16.0%)with growth hormone deficiencies(GHD),2 cases(2.0%)with suspected GH insensitivity syndrome(GHIS),14 cases(14.0%)with suspected GHD,68 cases(68.0%)with idiopathic dwarfism(ISS).The GH levels of GHD,suspected GHIS,suspected GHD and ISS dwarf children increased(P<0.05).The IGF-1 levels of the suspected GHD and ISS dwarf children were significantly higher than those in GHD and suspected GHIS dwarf children(P<0.05),and the IGFBP-3 levels were significantly higher than those in GHD and suspected GHIS dwarf children(P<0.05),while the IGF-1 levels of suspected GHIS dwarf children were significantly higher than those in GHD and suspected GHIS dwarf children(P<0.05),which were also significantly higher than that in GHD dwarf children(P<0.05),but the difference of IGFBP-3 level between the two groups was not significant(P>0.05),and the differences of IGF-1 and IGFBP-3 levels between suspected GHD,ISS dwarf children were not significant(P>0.05).Conclusion The majority of children with dwarfism are ISS,and the GH-IGF axis function test can help to determine the etiology and provide basis for clinical treatment.