邱明慧 董国庆

[摘要] 目的 了解不同病因的矮小儿童血清胰岛素样生长因子-1（IGF-1）和瘦素水平变化，探讨IGF-1和瘦素在生长激素缺乏症（GHD）诊断中的价值。 方法 选择深圳市妇幼保健院就诊的矮小儿童96例，年龄5~11岁，根据身高低于同性别同年龄均值-2~-3SD，排除其他可致身材矮小疾病，根据生长激素激发试验，GH峰值<10 ng/mL为GHD者共67例（GHD组）、GH峰值≥10 ng/mL为特发性矮小（ISS）者共29例（ISS组），另选择同期体检的生长发育正常儿童23名作为对照组。采集所有研究对象的外周静脉血3 mL，分离血清后，使用双抗体一步夹心法酶联免疫吸附实验（ELISA）测定血清IGF-1、瘦素浓度。 结果 GHD组血清IGF-1及瘦素水平[（45.7±19.02）μg/L、（4.25±0.63） mg/L]低于ISS组[（114.07±24.45）μg/L、(4.69±0.69) mg/L]和对照组[（164.61±46.22）μg/L、(6.27±0.89) mg/L]），组间比较，差异均有高度统计学意义（P < 0.01）；诊断GHD，IGF-1的敏感度为100%，特异度为98%；瘦素的敏感度为88%，特异度为71%。 结论 IGF-1和瘦素的检测可能可作为筛查和诊断GHD有价值的指标，并对GHD与ISS的鉴别诊断也有着一定的临床意义。

[关键词] 胰岛素样生长因子-1；瘦素；生长激素缺乏症；特发性矮小

[中图分类号] R725[文献标识码] A[文章编号] 1673-7210（2014）06（c）-0038-04

Expression and clinical significance of the level of serum insulin-like growth factor-1 and leptin in children with short stature

QIU Minghui DONG Guoqing

Department of Pediatrics, Shenzhen Maternal and Child Health Care Hospital Affiliated to the Southern Medical University, Guangdong Province, Shenzhen518028, China

[Abstract] Objective To understand the levels of serum insulin-like growth factor-1 (IGF-1) and leptin and to discuss the value of IGF-1 and leptin in the diagnosis of growth hormone deficiency (GHD). Methods A total of 96 patients were recruited in Shenzhen Maternity and Child Healthcare Hospital, whose height lower than -2--3SD of the same age and the same sex mean height, to rule out other diseases can cause short stature, according to growth hormone stimulation test, children with GHD whose GH peak <10 ng/mL were as GHD group (n=67), children with idiopathic short stature (ISS) whose GH peak≥10 ng/mL were as ISS group (n=29). The age of patients were at a range of 5-11 years, 23 children aged from 5 to 11 years old whose physical development were natural were chosen as control group. 3 mL peripheral blood of all subjects was chosen as the sample. The concentration of serum IGF-1 and leptin was measured by double antibody step clip art enzyme-linked immunosorbent assay (ELISA) method. Results The levels of serum IGF-1 and leptin in GHD group [(45.7±19.02) μg/L, (4.25±0.63) mg/L] were significantly lower than those of ISS group [(114.07±24.45) μg/L, (4.69±0.69) mg/L], and control group [(164.61±46.22) μg/L, (6.27±0.89) mg/L], the differences were highly statistically significant (P < 0.01). The diagnostic sensitivity of the IGF-1 was 100%, and the specificity was 98%; the diagnostic sensitivity of the leptin was 88%, and specificity was 71%. Conclusion The detection of IGF-1 and leptin can be used as the screening and diagnosis of GHD valuable indicators, and it also has a certain clinical significance to the differential diagnosis of GHD and the ISS.

[Key words] Insulin-like growth factor-1; Leptin; Growth hormone deficiency; Idiopathic short stature

身材矮小是儿科内分泌门诊常见的症状之一，临床上身材矮小患儿的病因多为生长激素缺乏症（growth hormone deficiency，GHD）和特发性矮小（idiopathic short stature，ISS），也有甲状腺功能低下、营养不良、Turner综合征等[1]。GHD是指因垂体前叶分泌的生长激素（GH）不足而导致儿童生长发育障碍、身材矮小者。而ISS是一种暂时尚无可认知原因的矮身材，包括GH不敏感、正常变异性矮身材、GH神经分泌功能紊乱、特发性生长障碍和非GH缺乏性身材矮小等[2]。GH的促生长效应主要是通过胰岛素样生长因子-1（IGF-1）实现的，IGF-1作为生长激素-胰岛素样生长因子轴（GH-IGF）极为重要的因子，其血清浓度能反映GH-IGF轴功能，其缺乏可表现为显著的低出生体重和身长，生后生长发育落后，小头畸形、耳聋及智力发育落后等[3]。而瘦素在人体能量代谢和生长发育中也起关键性调节作用，其主要是由脂肪组织合成的激素，能反映体脂含量[4]。近年来，瘦素与下丘脑垂体激素间的联系日益引起注意，瘦素与IGF-1代谢轴可能存在着一定的关系。本研究应用ELISA法检测血清IGF-1和瘦素水平，比较GHD、ISS患儿与正常儿童血IGF-1和瘦素的差异，以探讨GHD、ISS与IGF-1、瘦素的关系。……