重组人生长激素对特发性矮小症儿童血清IGF-1/IGFBP-3摩尔比的影响及其临床意义

Effects of recombinant human growth hormone on serum IGF-1/IGFBP-3 molar ratio in children with idiopathic short stature and its clinical significance

目的:探讨重组人生长激素(rhGH)对特发性矮小症(ISS)儿童血清胰岛素样生长因子-1(IGF-1)/IGF结合蛋白-3(IGFBP-3)摩尔比的影响及临床意义。方法:收集我院2016年6月至2020年6月收治的132例学龄期ISS儿童的临床和实验室记录进行回顾性分析,所有儿童接受至少2年的rhGH治疗。采用化学发光法测定血清IGF-1和IGFBP-3浓度,并计算摩尔比。rhGH治疗前后数据差值(Δ)=治疗后值-治疗前值。rhGH治疗1年后Δ身高标准差分值(SDS)<0.3定义为治疗反应不良,Δ身高SDS≥0.3定义为治疗反应良好。结果:与基线相比,rhGH治疗1年和2年身高SDS、IGF-1 SDS、IGFBP-3 SDS以及IGF-1/IGFBP-3摩尔比SDS均增加(P<0.05)。rhGH治疗反应不良的学龄期ISS儿童基线时的实际年龄、骨龄明显高于反应良好儿童,同时IGF-1/IGFBP-3摩尔比和IGF-1/IGFBP-3摩尔比SDS明显低于反应良好儿童(P<0.05)。经多因素Logistic回归分析,基线时IGF-1/IGFBP-3摩尔比SDS较低是rhGH治疗反应不良的独立危险因素(P<0.001)。rhGH治疗1年或2年后的Δ身高SDS与ΔIGF-1/IGFBP-3摩尔比、ΔIGF-1/IGFBP-3摩尔比SDS呈正相关(P<0.05)。进一步校正作为协变量的基线身高后,治疗2年后Δ身高SDS与ΔIGF-1/IGFBP-3摩尔比SDS呈正相关(P<0.05)。结论:血清IGF-1/IGFBP-3摩尔比SDS与rhGH治疗后身高增加反应相关,可能适合作为预测学龄期ISS儿童接受rhGH治疗后身高反应的生物标志物。

Objective:To investigate the effect and clinical significance of recombinant human growth hormone(rhGH)on serum insulin-like growth factor-1(IGF-I)/IGF-binding protein-3(IGFBP-3)molar ratio in children with idiopathic short stature(ISS).Methods:From June 2016 to June 2020,the clinical and laboratory records of 132 school-age ISS children admitted to our hospital were collected for retrospective analysis.All children had received rhGH treatment for at least 2 years.Serum IGF-1 and IGFBP-3 concentrations were measured by chemiluminescence method,and the molar ratio was calculated.rhGH data difference before and after treatment(Δ)=Data value after treatment-data value before treatment.After 1 year of rhGH treatment,poor response was defined asΔheight standard deviation score(SDS)<0.3,and good response was defined asΔheight SDS≥0.3.Results:Compared with baseline,the height SDS,IGF-1 SDS,IGFBP-3 SDS and IGF-1/IGFBP-3 molar ratio SDS increased after 1 and 2 years of rhGH treatment(P<0.05).The actual age and bone age of school-age ISS children with poor response to rhGH treatment at baseline were significantly higher than those with good response,and IGF-1/IGFBP-3 molar ratio and IGF-1/IGFBP-3 molar ratio SDS were significantly lower than those with good response(P<0.05).Multivariate Logistic regression analysis showed that lower IGF-1/IGFBP-3 molar ratio SDS at baseline was an independent risk factor for poor response to rhGH treatment(P<0.001).After 1 year or 2 years of rh GH treatment,ΔHeight SDS was positively correlated withΔIGF-1/IGFBP-3 molar ratio andΔIGF-1/IGFBP-3 molar ratio SDS(P<0.05).After further adjusting baseline height as a covariable,ΔHeight SDS was significantly positively correlated withΔIGF-1/IGFBP-3 molar ratio SDS after 2 years of treatment(P<0.05).Conclusion:Serum IGF-1/IGFBP-3 molar ratio SDS is related to the height increase response after rhGH treatment,and may be suitable as a biomarker to predict the height response of school-age ISS children after rhGH treatment.