Klotho、成纤维细胞生长因子23在矮身材儿童的水平变化及其与GH-IGF1轴的关系

Changes in levels of Klotho and fibroblast growth factor 23 in children with short stature and their correlations with the GH-IGF1 axis

目的探讨Klotho、成纤维细胞生长因子23(FGF23)在矮身材儿童的水平变化及其与生长激素(GH)-胰岛素样生长因子1(IGF1)轴的关系。方法选取2021年3月—2021年11月在河北省人民医院儿童保健门诊就诊的身材矮小的67例患儿作为研究组,并分为生长激素缺乏症组(GHD组)、特发性研究组(ISS组),分别有26和41例。另选取同期于该院儿童保健门诊行常规体格检查的正常身材儿童29例作为对照组。检测并比较研究组与对照组血清Klotho、FGF23、IGF1、胰岛素样生长因子结合蛋白3(IGFBP3)、血清钙、1,25-二羟维生素D3、磷酸盐水平。结果GHD组、ISS组身高-标准差数值(SDS)、体重-SDS均低于对照组(P<0.05)。各组年龄、性别、性发育分期、BMI-SDS比较,差异均无统计学意义(P>0.05)。GHD组IGF1、IGFBP3、Klotho、FGF23水平低于ISS组、对照组(P<0.05)。Spearman相关性分析结果显示,Klotho与IGF1、IGFBP3、FGF23、磷酸盐均呈正相关(rs=0.628、0.512、0.495和0.266,均P<0.05)。FGF23与IGF1、IGFBP3、磷酸盐均呈正相关(rs=0.440、0.484和0.277,均P<0.05)。结论GHD患儿Klotho、FGF23水平低下。Klotho、FGF23通过参与GH-IGF1轴的调节,在GHD患儿线性生长中发挥一定作用,并且在矮身材儿童血清磷酸盐稳态调节中有重要意义。

Objective To explore the changes in levels of Klotho and fibroblast growth factor 23(FGF23)in children with short stature and their correlations with the growth hormone(GH)-insulin-like growth factor 1(IGF1)axis.Methods The 67 children in the pediatric health care clinic of Hebei General Hospital from March 2021 to November 2021 were included as the study group,and were divided into the growth hormone deficiency(GHD)group and the idiopathic short stature(ISS)group,with 26 and 41 cases in each group,respectively.Another 29 children with normal stature who underwent routine physical examinations at the same pediatric health care clinic during the same period were selected as the control group.Serum levels of Klotho,FGF23,IGF1,insulin-like growth factor binding protein 3(IGFBP3),calcium,1,25-dihydroxyvitamin D3,and phosphates were measured and compared between the study group and the control group.Results The height standard deviation score(SDS)and the weight SDS were different among the groups(P<0.05),where those in the GHD group and the ISS group were lower than those in the control group(P<0.05).There was no difference in age,sex composition,sexual maturity rating and BMI-SDS among the groups(P>0.05).The levels of IGF1,IGFBP3,Klotho and FGF23 in the GHD group were lower than those in the ISS group and the control group(P<0.05).The Spearman correlation analysis showed that the level of Klotho was positively correlated with the levels of IGF1,IGFBP3,FGF23 and phosphates(rs=0.628,0.512,0.495 and 0.266,all P<0.05).The level of FGF23 was in positive correlation with the levels of IGF1,IGFBP3 and phosphates(rs=0.440,0.484 and 0.277,all P<0.05).Conclusions The levels of Klotho and FGF23 are low in children with GHD.Klotho and FGF23 play a significant role in linear growth in children with GHD by participating in the regulation of the GH-IGF1 axis,and they are important in regulating serum phosphate homeostasis in children with short stature.