左向右分流型先天性心脏病合并心力衰竭患儿血清IGF-1和IGFBP-3的变化及意义

Changes in serum insulin-like growth factor-1 and insulin-like growth factor-binding protein-3, and their significance in children with left-to-right shunt congenital heart disease associated with heart failure

摘要:

目的：探讨左向右分流型先天性心脏病（先心病）合并心力衰竭（心衰）患儿血清胰岛素样生长因子-1（IGF-1）和胰岛素样生长因子结合蛋白-3(IGFBP-3)的变化及意义。方法：20例健康儿童（对照组），20例无心脏基础疾病的心衰患儿（心衰组），20例无心衰的左向右分流型先心病患儿（先心组），30例伴心衰的左向右分流型先心病患儿（先心+心衰组）作为研究对象。对不同组别的血清IGF-1及IGFBP-3进行比较；并对先心+心衰组患儿按心功能Ⅱ、Ⅲ、Ⅳ级分为3个亚组，对其血清IGF-1、IGFBP-3及cTnI水平进行比较及相关性分析。结果：先心组血清IGF-1及IGFBP-3水平下降，与对照组比较差异有统计学意义(P<0.01)。先心+心衰组血清IGF-1水平明显下降，与对照组及先心组比较差异有统计学意义(分别P<0.01，P<0.05)。心衰组血清IGF-1及IGFBP-3水平明显增高，与其他各组比较差异有统计学意义(P<0.01)。先心+心衰组患儿按心功能分级比较的各亚组间随心功能下降血清IGF-1水平依次降低(P<0.01)，且该组患儿血清IGF-1、IGFBP-3水平与血清cTnI水平呈负相关（分别r=-0.692、-0.530，P<0.05）。结论：血清IGF-1水平可作为左向右分流型先心病病情评估的客观指标及合并心衰的危险因素，这也为该类患儿使用外源性IGF-1治疗心衰提供了临床依据。

Abstract:

OBJECTIVE: To investigate changes in serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) and their significance in children with left-to-right shunt congenital heart disease (CHD) associated with heart failure (HF). METHODS: Twenty healthy children (control group), 20 children with HF, without basic heart disease (HF group), 20 children with left-to-right shunt CHD, without HF (CHD group), and 30 children with left-to-right shunt CHD associated with HF (CHD+HF group) were included in the study. These groups were compared in terms of serum IGF-1 and IGFBP-3 levels. According to the New York Heart Association (NYHA) Functional Classification, the CHD+HF group was further divided into NYHA-II, NYHA-III and NYHA-IV subgroups and the subgroups were compared in terms of serum IGF-1, IGFBP-3, and cardiac troponin I (cTnI) levels. The correlation of serum IGF-1 and IGFBP-3 levels with serum cTnI level in the CHD+HF group was analyzed. RESULTS: The CHD group showed decreased serum IGF-1 and IGFBP-3 levels compared with the control group (P<0.01). The CHD+HF group showed a significantly decreased serum IGF-1 level compared with the control group (P<0.01) and CHD group (P<0.05). The HF group had significantly increased serum IGF-1 and IGFBP-3 levels compared with other groups (P<0.01). The NYHA-II subgroup had the highest serum IGF-1 level and the NYHA-IV subgroup had the lowest serum IGF-1 level (P<0.01). In the CHD+HF group, serum IGF-1 and IGFBP-3 levels were negatively correlated with serum cTnI level (r=-0.692, P<0.05; r=-0.530, P<0.05). CONCLUSIONS: Serum IGF-1 level can be used as an objective condition evaluation indicator for CHD, and low serum IGF-1 level is a risk factor for HF. This also provides a clinical basis for treatment of HF using exogenous IGF-1.