儿童I型糖尿病青春发育前及青春期血清IGF-I和IGFBP-3水平监测  

Serum Levels of IGF-I and IGFBP-3 in Prepubertal and Pubertal Children with Type I Diabetes Mellitus

作　　者：方昕[1] 沈水仙[1] 杨毅[2] 罗飞宏[1] 支涤静[1] 曾纪骅 

机构地区：[1]复旦大学附属儿科医院内科,上海200032 [2]复旦大学附属儿科医院分子生物室,上海200032 [3]复旦大学附属儿科医院同位素室,上海200032

出　　处：《中国当代儿科杂志》2001年第5期515-518,共4页Chinese Journal of Contemporary Pediatrics

摘　　要：目的　研究儿童Ⅰ型糖尿病青春发育前及青春期血清胰岛素样生长因子 I(IGF I) ,胰岛素样生长因子结合蛋白 3(IGFBP 3)水平变化 ,探讨生长激素 胰岛素样生长因子 I(GH IGF I)轴与血糖控制的关系。方法分别采用ELISA和免疫放射法测定 6 3例Ⅰ型糖尿病患儿和 47例正常对照血清IGF I,IGFBP 3水平 ,用胶乳凝集法测定Ⅰ型糖尿病患儿的糖化血红蛋白 (HbAIC)。结果　①青春发育前糖尿病患儿血IGF I为 (75 .4± 2 6 .6 )ng/ml,IGFBP 3为 (2 75 6 .1± 76 3.8)ng/ml,与对照组 [(10 3.9± 46 .5 )ng/ml,(2 717.1± 480 .2ng/ml]相比无统计学差异 (P >0 .0 5 ) ;但青春期糖尿病患儿血IGF I和IGFBP 3[(178.2± 6 5 .9)ng/ml,(2 95 6 .0± 847.6 )ng/ml]均低于对照组 [(2 2 9.6± 5 4.5 )ng/ml,(3393.2± 748.9)ng/ml) ]P <0 .0 5。②新发病的I型糖尿病患儿胰岛素治疗后血IGF I为 (143.0± 6 7.5 )ng/ml,IGFBP 3为 (2 740 .0± 44 9.8)ng/ml,较治疗前 [(5 4.8± 44 .3)ng/ml,(2 2 33.8± 336 .2 )ng/ml]明显升高 (P <0 .0 5 )。③糖尿病组HbAIC 与血IGF I ,IGFBP 3之间存在负相关关系(r =- 0 .32 ,- 0 .2 9,P <0 .0 1或 0 .0 5 )。④糖尿病组青春期HbAIC为 (9.0± 1.8) % ,每日胰岛素用量为 (0 .86±0 .30 )U/kg ,?Objective To study serum insulin like growth factor I (IGF I) and IGF I binding protein 3 (IGFBP 3) in children with type I diabetes mellitus (DM) and to explore the relationship between GH IGF I axis and blood sugar. Methods ELISA and immunoradioassay were used respectively for IGF I and IGFBP 3 determination in 63 children with type I DM and 47 normal children. Results ①Before puberty, there was no statistical difference in serum levels of IGF I and IGFBP 3 between the diabetic group and control group; but in puberty, serum levels of IGF I[( 178.2 ± 65.9 ) ng/ml] and IGFBP 3[( 2 956.0 ± 847.6 ) ng/ml] in the diabetic group were significantly lower than those of the control group [( 229.6 ± 54.5 ) ng/ml, ( 3 393.2 ± 748.9 ) ng/ml](P< 0.01 or 0.05 ). ② Serum levels of IGF I andIGFBP 3 [( 143.0 ± 67.5 ) and ( 2 740.0 ± 449.8 ) ng/ml] were elevated in children with recent onset type I DM after insulin therapy compared with the pre treatment group [( 54.8 ± 44.3 ) and ( 2 233.8 ± 336.2 ) ng/ml](P< 0.05 ). ③ In the diabetic group, HbA IC was negatively correlated to serum levels of IGF I (r= -0.32 , P< 0.01 ) and IGFBP 3 (r= -0.29 , P< 0.05 ). ④ In the diabetic group, HbA IC and insulin dose in puberty were higher than those in pre puberty [( 9.0 ± 1.8 )% vs ( 7.8 ± 1.8 )%, ( 0.86 ± 0.30 ) U/kg vs ( 0.64 ± 0.38 ) U/kg](P< 0.05 ). Conclusions Serum levels of IGF I and IGFBP 3 decrease in children with type I DM, especially during puberty. This suggests that GH IGF I axis is severely disturbed in these adolescents, probably an important cause of poor blood sugar control.

关 键 词：I型糖尿病 胰岛素样生长因子-I 胰岛素样生长因子结合蛋白-3 儿童 

分 类 号：R725.8[医药卫生—儿科]