难治性肾病综合征患儿生长激素-胰岛素样生长因子轴的变化及意义

Variation of GH2IGF Axis in Children with the Refractory Nephrotic Syndrome

摘要:

目的：观察难治性肾病综合征(RNS)患儿生长激素(GH)-胰岛素样生长因子(IGF)轴的变化及意义。方法：计算26例RNS患儿的身高标准差积分(HtSDS)，以双抗放射免疫法和免疫放射法检测血、尿IGFI及其结合蛋白3(IGFBP3)水平和血GH基础值，以同年龄组正常儿童(NC组，n=18)作对照。结果：RNS组血IGFI(152.68±120.95) ng/ml，IGFBP3(2 183.33±1 711.33) ng/ml低于NC组(255.68±46.92) ng/ml，(4 333.87±1 122.00) ng/ml，(P<0.05)，尿IGFI(5.32±2.84) ng/mg肌酐，IGFBP3(16.38±8.55) ng/mg肌酐高于NC组(0.90±0.37) ng/mg肌酐，(5.13±1.64) ng/mg肌酐，(P<0.05)；RNS组的血GH水平虽低于NC组，但P>0.05。RNS组身高标准差积分(HtSDS)(-0.42±0.75)低于NC组(0.30±0.17)，(P<0.05)。结论：RNS患儿存在GHIGF轴的变化，此变化为RNS患儿生长障碍的主要原因之一。

Abstract:

OBJECTIVE: To observe the variation of GH2IGF axis in children with the refractory nephrotic syndrome (RNS) . METHODS:  Serum and urine levels of IGF2I and IGFBP23 and baseline serum levels of GH were assayed using
RIA and IRMA in 26 patients with RNS , and hight standard deviation score (HtSDS) was calculated. Eighteen healthy children of similar ages were used as the control group (NC group) . RESULTS: Serum IGF2I [ (152. 68 ±120. 95) ng/ ml ] and IGFBP23 [ (2 183. 33 ±1 711.33) ng/ ml ] levels in the RNS group were significantly lower than those of the NC group [ (255. 68 ±46. 92) ng/ ml, 4 333.87 ±1 122.00) ng/ ml ] (P<0.05), and urine IGF2I [ (5. 32 ±2. 84) ng/ mg creatinine ] and IGFBP23 [ (16. 38 ±8. 55) ng/ mg creatinine ] levels were higher than those of the NC group [ (0.90 ±0.37) ng/ mg creatinine, (5.13 ±1. 64) ng/ mg creatinine ] ( P<0.05). The serum GH level was lower than that of the NC group, but didn’t achieve any statistical significance. HtSDS (-0.42±0.75) of the RNS group was lower than that of the NC group (0.30±0.17) (P<0.05). CONCLUSIONS: A disorder of the GH2IGF axis was detected in children with RNS. This abnormality may contribute to the growth failure seen in RNS.