矮小兒童血清胰島素樣生長因子-1和瘦素水平的表達及臨床意義

邱明慧 董國慶

[摘要] 目的 了解不同病因的矮小兒童血清胰島素樣生長因子-1（IGF-1）和瘦素水平變化，探討IGF-1和瘦素在生長激素缺乏癥（GHD）診斷中的價值。 方法 選擇深圳市婦幼保健院就診的矮小兒童96例，年齡5~11歲，根據身高低于同性別同年齡均值-2~-3SD，排除其他可致身材矮小疾病，根據生長激素激發試驗，GH峰值<10 ng/mL為GHD者共67例（GHD組）、GH峰值≥10 ng/mL為特發性矮小（ISS）者共29例（ISS組），另選擇同期體檢的生長發育正常兒童23名作為對照組。采集所有研究對象的外周靜脈血3 mL，分離血清后，使用雙抗體一步夾心法酶聯免疫吸附實驗（ELISA）測定血清IGF-1、瘦素濃度。 結果 GHD組血清IGF-1及瘦素水平[（45.7±19.02）μg/L、（4.25±0.63） mg/L]低于ISS組[（114.07±24.45）μg/L、(4.69±0.69) mg/L]和對照組[（164.61±46.22）μg/L、(6.27±0.89) mg/L]），組間比較，差異均有高度統計學意義（P < 0.01）；診斷GHD，IGF-1的敏感度為100%，特異度為98%；瘦素的敏感度為88%，特異度為71%。 結論 IGF-1和瘦素的檢測可能可作為篩查和診斷GHD有價值的指標，并對GHD與ISS的鑒別診斷也有著一定的臨床意義。

[關鍵詞] 胰島素樣生長因子-1；瘦素；生長激素缺乏癥；特發性矮小

[中圖分類號] R725[文獻標識碼] A[文章編號] 1673-7210（2014）06（c）-0038-04

Expression and clinical significance of the level of serum insulin-like growth factor-1 and leptin in children with short stature

QIU Minghui DONG Guoqing

Department of Pediatrics, Shenzhen Maternal and Child Health Care Hospital Affiliated to the Southern Medical University, Guangdong Province, Shenzhen518028, China

[Abstract] Objective To understand the levels of serum insulin-like growth factor-1 (IGF-1) and leptin and to discuss the value of IGF-1 and leptin in the diagnosis of growth hormone deficiency (GHD). Methods A total of 96 patients were recruited in Shenzhen Maternity and Child Healthcare Hospital, whose height lower than -2--3SD of the same age and the same sex mean height, to rule out other diseases can cause short stature, according to growth hormone stimulation test, children with GHD whose GH peak <10 ng/mL were as GHD group (n=67), children with idiopathic short stature (ISS) whose GH peak≥10 ng/mL were as ISS group (n=29). The age of patients were at a range of 5-11 years, 23 children aged from 5 to 11 years old whose physical development were natural were chosen as control group. 3 mL peripheral blood of all subjects was chosen as the sample. The concentration of serum IGF-1 and leptin was measured by double antibody step clip art enzyme-linked immunosorbent assay (ELISA) method. Results The levels of serum IGF-1 and leptin in GHD group [(45.7±19.02) μg/L, (4.25±0.63) mg/L] were significantly lower than those of ISS group [(114.07±24.45) μg/L, (4.69±0.69) mg/L], and control group [(164.61±46.22) μg/L, (6.27±0.89) mg/L], the differences were highly statistically significant (P < 0.01). The diagnostic sensitivity of the IGF-1 was 100%, and the specificity was 98%; the diagnostic sensitivity of the leptin was 88%, and specificity was 71%. Conclusion The detection of IGF-1 and leptin can be used as the screening and diagnosis of GHD valuable indicators, and it also has a certain clinical significance to the differential diagnosis of GHD and the ISS.

[Key words] Insulin-like growth factor-1; Leptin; Growth hormone deficiency; Idiopathic short stature

身材矮小是兒科內分泌門診常見的癥狀之一，臨床上身材矮小患兒的病因多為生長激素缺乏癥（growth hormone deficiency，GHD）和特發性矮小（idiopathic short stature，ISS），也有甲狀腺功能低下、營養不良、Turner綜合征等[1]。GHD是指因垂體前葉分泌的生長激素（GH）不足而導致兒童生長發育障礙、身材矮小者。而ISS是一種暫時尚無可認知原因的矮身材，包括GH不敏感、正常變異性矮身材、GH神經分泌功能紊亂、特發性生長障礙和非GH缺乏性身材矮小等[2]。GH的促生長效應主要是通過胰島素樣生長因子-1（IGF-1）實現的，IGF-1作為生長激素-胰島素樣生長因子軸（GH-IGF）極為重要的因子，其血清濃度能反映GH-IGF軸功能，其缺乏可表現為顯著的低出生體重和身長，生后生長發育落后，小頭畸形、耳聾及智力發育落后等[3]。而瘦素在人體能量代謝和生長發育中也起關鍵性調節作用，其主要是由脂肪組織合成的激素，能反映體脂含量[4]。近年來，瘦素與下丘腦垂體激素間的聯系日益引起注意，瘦素與IGF-1代謝軸可能存在著一定的關系。本研究應用ELISA法檢測血清IGF-1和瘦素水平，比較GHD、ISS患兒與正常兒童血IGF-1和瘦素的差異，以探討GHD、ISS與IGF-1、瘦素的關系。……