血浆置换对重型肝炎患者血清生长激素-胰岛素样生长因子轴的影响  

Clinical study of plasma exchange on the growth hormone and insulin-like growth factors axis in patients with severe hepatitis

作　　者：王宝华[1] 宋树芬[1] 高晓卡 田字彬[2] 

机构地区：[1]青岛市传染病医院血液净化中心,266033 [2]青岛大学医学院附属医院消化科

出　　处：《中华传染病杂志》2007年第4期228-231,共4页Chinese Journal of Infectious Diseases

摘　　要：目的了解重型肝炎患者血清生长激素-胰岛素样生长因子轴(GH-IGF)在血浆置换(PE)前后的变化和意义。方法治疗组46例重型肝炎患者均给予内科综合治疗及PE治疗,PE治疗前后分别测定血清GH、IGF-2及肝生化指标。正常对照组同时检测GH、IGF-2。结果重型肝炎组与正常组比较,血清GH水平明显升高[(3.99±2.87)μg/L对(1.53±0.89)μg/L,P<0.01],IGF-2水平明显降低[(0.32±0.13)μg/L对(0.44±0.14)μg/L,P<0.01]。重型肝炎存活组与死亡组比较,GH升高差异无统计学意义,而IGF-2明显高于死亡组。PE治疗有效率为82.6%,肝功能及PTA好转(P<0.05或P<0.01),GH变化差异无统计学意义[(3.99±2.87)μg/L对(3.53±2.32)μg/L,P>0.05],IGF-2明显升高[(0.32±0.13)μg/L对(0.41±0.14)μg/L,P<0.01],GH与IGF-2呈负相关(r=-0.35,P<0.01)。结论重型肝炎患者GH-IGF轴发生显著改变,PE是治疗重型肝炎的方法之一,对GH-IGF轴具有调节作用。Objectives To investigate level of growth hormone（GH）, insulin-like growth factor-2（IGF-2） in patients with severe hepatitis, and to survey the clinical significance of changes in GH-IGF axis after the treatment of plasma exchange（PE）. Methods Forty-six patients with severe hepatitis in the treatment group were treated with the comprehensive protective therapy in addition to PE. Serum biochemical tests, GH and IGF-2 were compared before and after treatments with PE. Thirty-five cases in heathy control group were detected GH and IGF-2. Results In patients with severe hepatitis, the serum concentrations of GH were significantly higher than that cases in healthy controls, （3.99 ± 2.87）ug/L vs （1.53 ± 0. 89）ug/L（P〈0. 01 ）; while the serum levels of IGF-2 were significantly decreased, （0.32±0.13）ug/L vs （0.44±0.14）ug/L（P〈0.01）. The serum IGF-2 was higher in the survival group than that in the fatality group（P〈0.01）. After treating with PE, the clinical symptoms and signs of all patients were improved, the total effectiveness rate was 82.6 %. Serun biochemical tests were ameliorated（P〈0.05, P〈0.01, respectively）. The change of serum GH was significant,（3.99±2.87）ug/L vs （2.63±2.32）ug/L, （P〈0.05） ; while the serum IGF-2 was increased,（0. 32 ±0.13）ug/L vs （0. 41±0.14）ug/L（P〈0. 01）. The serumGH showed a significantly negative relationship with the serum IGF-2（r= -0.35, P〈0.01）. Conclusions The GH- IGF axis is significantly abnormal in patients with severe hepatitis, suggesting the existence of GH resistance in these patients. PE can reduce GH resistance and increases the serum IGF-2, it is an effective therapy for severe hepatitis.

关 键 词：肝炎 病毒性 人 生长激素 胰岛素样生长因子Ⅱ 血浆置换 

分 类 号：R575.1[医药卫生—消化系统]