先天性心脏病患儿营养不良与生长激素-胰岛素样生长因子轴的关系  

Relationship between Onset of Malnutrition and Growth Hormone-Insulin-Like Growth Factor Axis in Children with Congenital Heart Disease

作　　者：韦丹[1] 陆元奉[2] 

机构地区：[1]广西医科大学第一附属医院儿科,南宁530027 [2]广西壮族自治区人民医院儿科,南宁530000

出　　处：《实用儿科临床杂志》2007年第8期579-580,598,共3页Journal of Applied Clinical Pediatrics

基　　金：广西科学基金项目资助(0447075)

摘　　要：目的探讨先天性心脏病(CHD)患儿营养不良与生长激素-胰岛素样生长因子(GH-IGF)轴的关系。方法依据有无发绀及心力衰竭,将50例CHD患儿分为发绀组13例、非发绀组37例;非发绀组又分为2个亚组:心力衰竭组25例、无心力衰竭组12例。20例健康儿童作为健康对照组,通过测定各组儿童血总蛋白、清蛋白及测量身高、体质量来评价其营养状况;采用免疫放射分析方法来检测血IGF-Ⅰ、胰岛素样生长因子结合蛋白-3(IGFBP-3)及生长激素结合蛋白(GHBP),并进行比较。结果CHD患儿急、慢性营养不良的发生率分别为62%和28%,急性营养不良的发生率发绀组与非发绀组相似(P=0.105);慢性营养不良的发生率发绀组高于非发绀组(P=0.006);各组CHD患儿血清IGF-Ⅰ、IGFBP-3水平均下降,其中发绀组及心力衰竭组下降更为显著;发绀组及心力衰竭组患儿血GHBP水平下降。结论CHD患儿血清IGF-Ⅰ和IGFBP-3水平下降,考虑与生长激素受体(GHR)有关,GHR下调可能是GH抵抗或不敏感的分子机制之一,而GH抵抗或不敏感是CHD患儿发生急、慢性营养不良的原因之一。Objective To investigate the relationship between onset of malnutrition and growth hormone - insulin - like growth factor （ GH - IGF） axis in children with congenital heart disease （CHD）. Methods Fifty cases with CHD were divided into two groups, 13 cases of cyanotic group and 37 cases of acyanotic group. And the acyanotic group was then subdivided into two groups,25 cases of heart failure group and 12 cases of without heart failure group, and 20 normal children were selected as control group. The nutritional status of these children were evaluated by detecting the serum total protein, serum protein, body height and weight. IGF - Ⅰ and insulin - like growth factor binding protein - 3 （ IGFBP - 3 ） and growth hormone binding protein（GHBP） were detected by immunoradiometric assay. Results The acute malnutrition ratio and chronic malnutrition ratio in the children with CHD were 62% and 28 % , respectively. The acute malnutrition ratio was similar between cyanotic group and acyanotic group（ P = 0. 105 ） ; the chronic malnutrition ratio significantly increased in cyanotic group than that in cyanotic group （ P = 0. 006）. The levels of serum IGF - Ⅰ and IGFBP -3 decreased in the patients with CHD, which significantly decreased in cyanotic group and heart failure group. The level of serum GHBP decreased in cyanotic group and heart failure group. Conclusions The levels of serum IGF - Ⅰ and IGFBP - 3 in patients with CHD decrease, which are related to growth hormone receptor down regulated,that is one of the molecular mechanisms of growth hormone resistant or insensitivity, growth hormone counteract or insensitivity are one of the reasons of acute and chronic malnutrition in children with CHD .

关 键 词：-心脏病 先天性 胰岛素样生长因子-Ⅰ 生长激素不敏感 营养障碍 

分 类 号：R725.4[医药卫生—儿科] R725.8[医药卫生—临床医学]