血液透析患者生长激素-胰岛素样生长因子轴与营养状态关系的研究

The relationship of GH- IGF axis and nutrition status in hemodialysis

目的 本研究观察透析患者生长激素(GH)、胰岛素样生长因子(IGF-Ⅰ)及其结合蛋白-1(IGFBP 1)、结合蛋白-3(IGFBP 3)与主要营养指标如血浆白蛋白、前白蛋白、转铁蛋白水平的关系,探索透析患者营养不良的原因。方法 ELISA法检测60例血液透析稳定患者血GH、IGF—Ⅰ及IGFBP 1、IGFBP3。同时检测血前白蛋白、转铁蛋白、白蛋白、总蛋白;另设15例健康对照组,年龄、性别与上匹配。分别用GH、IGF—Ⅰ、IGFBP 1、IGFBP 3与上述营养指标进行相关分析。结果 60例透析患者IGF—Ⅰ及IGFBP 3显著低于正常对照组,GH及IGFBP1显著增高,有统计学意义。GH与血浆白蛋白及氮平衡呈正相关关系;IGF—Ⅰ、IGFBP 3与血浆白蛋白、前白蛋白、转铁蛋白及氮平衡呈正相关,而IGFBP1与白蛋白呈负相关关系,P<0.05。结论 本研究证实,血液透析患者存在GH—IGF轴的紊乱,这些患者平均前白蛋白、转铁蛋白低于正常对照组,热量及蛋白摄入量低于推荐量。GH—IGF轴中的GH、IGF—Ⅰ、IGFBP 1、IGFBP 3与营养有一定的相关关系。

Objective Malnutrition generally exists in hemodialysis patients, and is a risk factor for poor quality of life and increased morbidity and mortality. The present study was to investigate the disorder of GH - IGF axis in HD patients.Methods Serum GH, IGF- I, IGFBP1 and IGFBP3 levels in 60 HD patients were detected, and PA, TF ALB, TB. DPI and DEI were calculated by diet investigation. Urine of 24 hours were collected and urea nitrogen and albumin were detected, so as to calculate UNA, and nitrogen blance. Results The value of serum IGF - Iand IGFBP1 of sixty HD patients were significantly lower than those of the control group, while GH and IGFBP3 were significantly higher. The levels of serum IGF- I and IGFBP3 were statistically correspondence with ALB, PAB,TRF and nitrogen balance. Serum IGFBP1 levels was native correspondence with ALB. Conclusion The disorder of GH - IGF axis existed in HD patients. GH,IGF-I, IGFBP 1 and IGFBP 3 were related with nutrition status.