窒息新生儿血清肌钙蛋白I和磷酸肌酸激酶

目的探讨血清肌钙蛋白I（cTnI）和磷酸肌酸激酶同工酶（CK—MB）对窒息新生儿心肌损伤的早期诊断价值。方法选择轻度窒息新生儿29例（轻度组）、重度窒息新生儿18例（重度组）。采用ELISA法和酶动力法检测新生儿血清cTnI水平和CK—MB活性。结果出生d1窒息新生儿血清cTnI和CK-MB水平在轻度组[（2．25±0．54）μg／L、（223．4±23．5）U／L]和重度组[（4．25±0，83）μg／L、（256．3±21．8）U／L]均显著高于对照组（Pα〈0．01）；重度组血清cTnI和CK-MB水平均显著高于轻度组（Pα〈0．01）。治疗后d7窒息新生儿血清cTnI和CK—MB水平均明显下降，轻度组[（0．69±0．18）μg／L、（151．4±18．4）U／L]与对照组均无显著差异（Pα〉0．05），重度组[（1．54±0．72）μg／L、（188．9±21．5）U／L]显著高于轻度组和对照组（Pα〈0．01）。结论窒息新生儿伴心肌损伤时血清cTnI和CK—MB水平升高；动态观察可用于窒息新生儿微小心肌损伤的早期诊断。     

多器官功能障碍综合征危重患儿血促胃液素、胃动素及胰岛素样生长因子变化的意义

目的对危重患儿多器官功能障碍（MODS）时血促胃液素（GAS）、胃动素（MTL）及胰岛素样生长因子-1（IGF-1）进行检测，探讨其水平变化与器官功能障碍或衰竭的关系。方法采用放射免疫法对危重患儿50例及非危重患儿30例血GAS、MTL及IGF-1进行检测，并与30例正常对照组进行比较。结果危重患儿血GAS、MTL及IGF-1各组均数差异有显著性（F=49．61，55.18，18．23 P均〈0．001）。胃肠功能障碍组血GAS、MTL及IGF-1水平变化与非胃肠功能障碍组比较差异有显著性（t=4．455，4．241，2．672 P均〈0．001）。危重患儿器官功能障碍中4个器官功能障碍与2个器官功能障碍比较，MTL与IGF-1差异有显著性，GAS差异无显著性。危重患儿治疗前后血GAS、MTL及IGF-1水平及非危重组与正常对照组比较差异有显著性（t=3．232，4．352，4．706 P均〈0．001）。结论危重患儿MODS时血GAS、MTL及IGF-1可能参与危重症病情的发展，且与胃肠功能障碍及MODS发生有关，结合患儿临床对其血GAS、MTL及IGF-I进行监测，对估计患儿病情严重程度及治疗有重要指导意义。     

窒息新生儿出生后血钙、磷、镁及甲状旁腺素变化

目的观察重度窒息足月新生儿出生后血清钙、磷、镁动态变化，及其与甲状旁腺激素（PTH）的关系。方法选择重度窒息新生儿30例，测定出生后24h、72h及7天时血清钙、磷、镁及甲状旁腺素，并与同期正常足月新生儿对照。结果（1）窒息组新生儿血清镁含量在出生后24h、72h明显低于对照组（P〈0．01）；血清钙含量在出生后1周均明显低于对照组（P〈0．01）；血清PTH含量在出生后24h、7天明显高于对照组（P〈0．01）；血清磷无明显差别。（2）窒息组中血清镁24h时，轻度HIE组明显低于无HIE组（P〈0．05）；血清PTH在24h时，中～重度HIE组明显高于无HIE组（P〈0．01），72h时轻度、中～重度HIE组均明显高于无HIE组（P分别〈0．05、〈0．01），7天时差异无显著性；血清钙、磷在不同程度HIE中差异无显著性；（3）窒息组中血镁与钙、血镁与PTH的水平均无明显相关性。结论新生儿窒息后血清镁降低，并与HIE严重程度有关。提示窒息缺氧后血镁降低在HIE的发病中可能起一定作用。     

窒息后新生儿血中表皮生长因子、神经降压素及生长抑素水平的研究及与临床因素关系的探讨

目的 通过对窒息新生儿表皮生长因子（Epidermal growth factor,EGF）、神经降压素（Neurotensin,NT）、生长抑素（Somatostatin,SS）的水平监测,EGF、NT、SS水平与临床因素关系的研究,探讨围产期窒息对消化道激素的影响。方法:采用放射免疫方法,动态测定了56例窒息新生儿和39例正常足月儿生后1、3、7天血中EGF、NT、SS水平的变化。结果与正常对照组比较:窒息新生儿血中NT、SS水平明显升高,EGF水平明显降低,差异显著,P<0.05;生后第7天窒息组EGF、SS水平恢复正常,但NT水平则仍较相应正常对照组升高（116.4,118.2vs 84.7ng/L）,P<0.01;与临床因素相关分析显示:EGF与1分钟Apgar评分呈正相关,r=0.3149,P<0.01;NT与1分钟Apgar评分呈负相关,r=-0.368,P<0.001;NT、EGF分别与胎龄、奶量呈正相关,P<0.01;SS与空腹血糖（FBS）呈正相关,r=0.222,P<0.05。结论 窒息后新生儿血中NT、SS浓度升高,EGF浓度降低,且与窒息程度有关。表明窒息新生儿胃肠激素水平异常,可能是造成患儿消化功能紊乱的因素之一。     

窒息新生儿血清胃泌素与胃酸分泌的动态观察

为探讨不同程度窒息对新生儿胃酸分泌及胃泌素水平的影响。对25例轻度窒息新生儿、20例重度窒息的新生儿于出生后1、3、7天检测血清胃泌素和胃液基础酸排量(BAO)。结果显示重度窒息组第1、3天的血清胃泌素水平明显低于轻度窒息组，而第1天胃液基础酸排量则高于轻度窒息组。结论重度窒息新生儿血清胃泌素水平较轻度窒息新生儿明显降低，而胃液基础酸排量增高，这可能是导致新生儿喂养不耐受、易致消化道出血的原因。     

窒息新生儿心肌肌钙蛋白Ⅰ测定及临床分析

目的 通过测定窒息新生儿心肌肌钙蛋白Ⅰ（cTnⅠ），探讨其与新生儿窒息及窒息后心肌损害的关系。方法 采用胶乳增强免疫比浊法测定48例轻度窒息儿，42例重度窒息儿，40例健康新生儿（对照组）血清cTnⅠ浓度，同时行心电图检查。结果 两组窒息儿血清cTnⅠ浓度均明显高于对照组（P〈0．01），重度窒息组高于轻度窒息组（0．01〈P〈0．05）。结论 cTnⅠ浓度与新生儿窒息程度密切相关：窒息越重，cTnⅠ值越高，心肌损害越严重。应常规检测窒息新生儿的cTnⅠ．以及时治疗．改善预后。     

窒息新生儿尿内皮素、尿微量蛋白的变化观察

目的 探讨尿内皮素(ET)、尿微量蛋白(a1-M、TRF、Alb)在新生儿窒息肾脏损害中的意义。方法 窒息组在生后第3天、第7天采用放射免疫法测定尿ET，同时测定其尿微量蛋白水平。对照组健康新生儿同期进行上述检测。结果 发现窒息组第3天尿ET含量明显高于对照组(P＜0．01)。且重度窒息组＞轻度窒息组＞对照组。第7天重度窒息组尿ET平均水平虽高于对照组、轻度窒息组，但统计显示无明显差异(P＞0．05)。尿微量蛋白( a1-M、TRF、Alb)变化与尿ET呈正相关(P＜0．01)。结论 尿ET与尿微量蛋白含量测定可以作为新生儿肾功能损伤的早期指标。新生儿窒息尿ET的增高与肾损害有密切关系。     

多普勒组织成像法评价窒息新生儿左心收缩功能

目的 探讨多普勒组织成像法（DTI）评价窒息新生儿左心收缩功能。方法 足月窒息新生儿根据出生时Apgar评分分成重度窒息组（Apgar评分≤3分）共31例，轻度窒息组（Apgar评分4-7分）共31例，在出生后24、48、72h内分别通过超声心动图检测左室射血分数（LVEF），然后转入DTI模式测定二尖瓣前叶收缩期运动速度（s），并与正常新生儿组30例相对照，同时检测心肌肌钙蛋白（cTnI）。结果 重度组LVEF在24h明显低于48h和72h（P〈0．001），亦明显低于轻度组和对照组（P〈0．01），除此之外，3组之间及3组各时段之间LVEF差异无统计学意义（P〉0．05）。DTI重度组、轻度组的s在3个时段均明显低于对照组（P〈0．001），且重度组s在24h亦明显低于48h和72h（P〈0．001），除此之外3组之间及3组各时段之间（s），差异无统计学意义（P〉0．05）。重度组cTnI在3个时段明显高于轻度组及对照组（P〈0．01），而轻度组与对照组比较，差异无统计学意义（P〉0．05）。结论 新生儿窒息时左心收缩功能降低，DTIs较LVEF更能反映窒息新生儿左心收缩功能的变化。     

窒息新生儿和早产儿血降钙素基因相关肽及血压的动态变化

为探讨重度窒息新生儿、早产儿血浆降钙素基因相关肽（CGRP）和血压的动态变化及临床意义，对20例足月重度窒息儿，18例早产儿及22例足月正常新生儿后第1、3、7天的血浆CGRP水平及BP值进行测定。结果显示，窒息组第1、3天血浆CGRP水平显著高于对照组（P＜0．05）。第7天与对照组差异无显著性（P＞0．05）；其BP值结果则相反；早产儿组第1、3、7天血浆CGRP水平和对照组相比差异均无显著性（P均＞0．05），BP值则均低于对照组（P均＜0．05）；窒息组中，第7天血浆CGRP值较高1、3天显著下降（P均＜0．05），BP值则相反；正常组和早产组的CGRP值在生后1、3、7均间均无显著变化（P均＞0．05），其BP值则逐渐升高（P均＜0．05）。提示CGRP参与新生儿窒息后病理生理过程，血浆CGRP的升高可能是窒息后机体自我保护机制之一；早产因素对血浆CGRP值影响不大；血浆CGRP不参与BP生理性增高过程。     

窒息新生儿血小板参数的动态变化及其意义

为了解窒息新生儿血小板数（PLT）、血小板平均容体（MPV）及血小板分布宽度（PDW）的变化及其临床意义，方法：采用全自动血细胞分析仪测定83例窒息新生儿及80例正常新生儿的PLT、MPV、及PDW。结果：新生儿窒息后，急性期PLT较正常对照组显著降低（P＜0．01），MPV和PDW则较对照组明显增高（P＜0．05），窒息组恢复期PLT、MPV和PDW与对照组比较，其差异无统计学意义（P＞0．05），且随着窒息程度加重，PLT愈下降（中度组与轻度组比较P＜0．001），而MPV、PDW则愈增高（中度组与轻度组比较P＜0．05，重度组与轻重度组比较P＜0．01），结论：血小板参数（PLT、MPV和PDW）可做为项判断新生儿窒息后病情严重程度并监测病情变化的指标。     

High levels of growth factors in human breast milk

We found very high concentrations of vascular endothelial growth factor, hepatic growth factor, and epidermal growth factor in early breast milk samples obtained from healthy mothers of term infants. This is the first report of simultaneous measurements of three major gastrointestinal trophic substances in human milk.     

L-精氨酸对宫内发育迟缓胎鼠胰岛素样生长因子及其结合蛋白表达的影响

目的：宫内发育迟缓(IUGR)儿常有脑发育的异常,L精氨酸具有舒张血管、增加胎盘血流的作用,可用于改善胎盘缺氧状态,促进胎儿生长发育。用被动吸烟法制作孕鼠IUGR模型,孕8～20d给予不同剂量L精氨酸,了解其对宫内发育迟缓胎鼠脑内胰岛素样生长因子及其结合蛋白表达的影响,并探讨L精氨酸的作用机制。方法：孕鼠随机分为4组:对照组、模型组、L精氨酸小剂量和大剂量防治组,每组9只。孕21d剖宫取胎,应用酶联免疫吸附法检测各组胎鼠脑组织胰岛素样生长因子Ⅰ(IGFⅠ)、胰岛素样生长因子Ⅱ(IGFⅡ)、胰岛素样生长因子结合蛋白(IGFBP3)含量,应用荧光定量RTPCR法检测各组胎鼠脑组织IGFⅠmRNA表达。结果：与对照组相比较,模型组胎鼠脑组织中IGFⅠ(0.789±0.062ng/mgvs0.947±0.042ng/mg)、IGFⅡ(0.270±0.020ng/mgvs0.374±0.015ng/mg)含量均比对照组明显降低,IGFBP3(0.253±0.011ng/mgvs0.089±0.015ng/mg)含量比对照组明显升高,IGFⅠmRNA表达量(13.12±1.39)×104cps/μgRNAvs(21.28±3.54)×104cps/μgRNA比对照组明显降低,差异均有显著性(P<0.01)。与模型组相比较,小剂量和大剂量L精氨酸防治组IGFⅠ含量明显增高,分别为0.937±0.067ng/mg和0.858±0.077ng/mg,IGFⅡ含量明显增高,分别为0.318±0.018ng/mg和0.354±0.021ng/mg,IGFBP3含量明显降低,分别为0.132±0.006ng/mg和0.146±0.009ng/mg差异有显著性(P<0.01或<0.05)。同时小剂量和大剂量L精氨酸防治组IGFⅠmRNA表达量也明显增高,分别为(19.24±2.48)×104cps/μgRNA和(17.35±2.30)×104cps/μgRNAvs(13.12±1.39)×104cps/μgRNA,差异均有显著性(P<0.01)。结论：L精氨酸可增加被动吸烟致宫内发育迟缓胎鼠脑内IGFⅠ、IGFⅡ含量和IGFⅠmRNA的表达,降低IGFBP3含量。L精氨酸防治IUGR的机制与其对胰岛素样生长因子及其结合蛋白表达的影响有关。     

Effects of insulin-like growth factor I treatment on the molecular distribution of insulin-like growth factors among different binding proteins

The molecular distribution of insulin-like growth factor I (IGF-I) and IGF-II among the IGF binding proteins (IGFBPs) was studied before and during IGF-I therapy in Ecuadorean adults with growth hormone receptor deficiency (GHRD). Of the total circulating IGF-I and IGF-II, 70% was carried by the 150 kDa complex in normal subjects, while in patients with GHRD, 50% of serum IGF-I, but only 30–35% of serum IGF-II, was measured within the 150 kDa IGFBP-3 region. Administration of IGF-I altered the concentration of IGF-I and IGF-II, although the percentage of total IGF measured within each IGFBP region was not affected, as the increase in IGF-I and the decrease in IGF-II were proportional. Similarly, serum concentrations of IGFBP-3 and the acid-labile subunit, measured by radioimmunoassay, were unaltered. Thus, administration of IGF-I to patients with GHRD was unable to correct the aberrant distribution of IGFs among the IGFBPs.     

Effects of recombinant human insulin-like growth factor I administration in adults with growth hormone deficiency

Recombinant human insulin-like growth factor I (IGF-I), 40 μg/kg/body weight, was administered subcutaneously at 08.00 hours to six adult patients with growth hormone deficiency (GHD). The mean maximal IGF-I concentrations were found 2–6 hours after injection. Concentrations then gradually declined, though mean values were still above basal 24 hours after the injection. Only one patient maintained IGF-I levels above the lower normal range throughout 24 hours. There was a significant decrease in mean IGF-II concentrations when measured 4 and 24 hours after injection of IGF-I. The diurnal variations of insulin and IGF binding protein-1 were preserved. There were no side-effects, and blood glucose remained normal. These results show that in patients with low IGF-I levels resulting from GHD, it is necessary to administer IGF-I at intervals of less than 24 hours to obtain IGF-I levels that are within the normal range.     

Role of epidermal growth factor and transforming growth factor α in the developing stomach

AIMS—To determine whether epidermal growth factor (EGF) or the related transforming growth factor α (TGFα) may have a role in the developing human stomach; to substantiate the presence of EGF in human liquor in the non-stressed infant and whether EGF in amniotic fluid is maternally or fetally derived.METHODS—The temporal expression and localisation of EGF, TGFα, and their receptors during fetal and neonatal life were examined in 20 fetal and five infant stomachs. Simultaneously, samples of amniotic fluid and fetal urine from 10 newborn infants were collected and assayed for EGF by radioimmunoassay.RESULTS—EGF immunoreactivity was not noted in any of the specimens examined. In contrast, TGFα immunoreactivity was shown in mucous cells from 18 weeks of gestation onwards. EGF receptor immunoreactivity was seen on superficial mucous cells in gastric mucosa from 18 weeks of gestation onwards. The median concentration of EGF was 30 and 8.5 pg/ml in amniotic fluid and fetal urine, respectively, suggesting that EGF is not produced by the fetus.CONCLUSIONS—This study adds weight to the hypothesis that swallowed EGF, probably produced by the amniotic membranes, and locally produced TGFα, may have a role in the growth and maturation of the human stomach.     

Good growth despite very low levels of insulin-like growth factors

A 12.5-year-old girl presented with short stature. Insulin-like growth factor 1(IGF-I) and insulin- like growth factor binding protein (IGFBP-3) were below the 0.1 percentile. Growth hormone provocation tests disclosed normal responses to l-arginine and insulin-induced hypoglycaemia. A huge benign mesenteric cyst was discovered by abdominal ultrasound and completely removed. Subsequently, the girl showed a marked catch-up growth; however, IGF-I and IGFBP-3 remained below the 0.1 percentile. Conclusion These observations imply that growth may take place even with very low levels of insulin-like growth factors. The interpretation of low IGF-I and IGFBP-3 levels in short children still requires good clinical judgement and basic knowledge of their biological action. Received: 24 September 1997 / Accepted in revised form: 16 March 1998     

生长发育迟缓与胰岛素样生长因子的关系

目的提高由于生长激素－胰岛素样生长因子（ＧＨ－ＩＧＦ）轴异常引起的生长发育迟缓诊断的准确性。方法分别收集门诊６８例生长发育迟缓儿童运动激发试验前后２次血清和１４例住院患儿药物激发试验１０次血标本,用免疫放射计量（ＩＲＭＡ）方法测定ＩＧＦ－１,ＩＧＦ－２和ＩＧＦＢＰ－３,放免方法（ＲＩＡ）测定ＧＨ。结果药物激发试验ＧＨ水平与ＩＧＦ－１,ＩＧＦ－２和ＩＧＦＢＰ－３测定一致。运动激发试验根据运动后ＧＨ水平及身高百分位的情况将６８例分为３组：ＧＨ＜５０μｇ／Ｌ,５０～１００μｇ／Ｌ,＞１００μｇ／Ｌ。ＧＨ＜５０μｇ／Ｌ组１４例,其中１０例身高小于第３百分位,其ＩＧＦ－１,ＩＧＦ－２和ＩＧＦＢＰ－３水平分别是（３９±２０）,（２７４±１２２）,（４２０±２１０）ｎｍｏｌ／Ｌ,低于正常值（Ｐ＜００１）,ＧＨ水平与ＩＧＦ－１,ＩＧＦ－２和ＩＧＦＢＰ－３相符。结论用运动激发试验联合测定ＧＨ、ＩＧＦ－１和ＩＧＦＢＰ－３三项指标可以提高由于ＧＨ－ＩＧＦ轴异常所引起的生长发育迟缓诊断的准确性。     

性早熟女性患儿血清IGF-1和IGFBP-3质量浓度检测及临床价值

目的　探讨女性特发性中枢性性早熟(ICPP)及乳房早发育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 )的关系及临床意义。方法　以放射免疫法测定于2 0 0 0年5月至2 0 0 4年1月在暨南大学医学院第二附属医院就诊的2 2例ICPP及2 8例乳房早发育女孩血清IGF- 1和IGFBP -3的水平,并以2 5名正常青春发育期女孩及3 0名未发育女孩作为对照,以IGF- 1、IGFBP- 3为诊断指标,对ICPP进行诊断试验评价。结果　ICPP女性患儿血清IGF -1、IGFBP- 3水平均明显高于乳房早发育及未发育女孩(P <0 .0 1 ) ,而与正常青春发育女孩差别无显著性意义(P >0 .0 5)。IGF- 1 >2 69 .1 4mg/L对诊断ICPP的灵敏度、特异度、阳性预测值、准确度分别为95% ,96% ,95% ,96% ;IGFBP -3 >3 53 6 42mg/L对诊断ICPP的灵敏度、特异度、阳性预测值、准确度分别为72 % ,96% ,94% ,86%。结论　ICPP女性患儿血清IGF 1、IGFBP- 3水平明显增高,IGF -1、IGFBP -3对鉴别ICPP与乳房早发育具有临床意义。     

Developmental pattern of fetal growth hormone,insulin-like growth factor I,growth hormone binding protein and insulin-like growth factor binding protein-3

AIMS—To evaluate the developmental pattern of fetal growth hormone (GH), insulin-like growth factor I (IGF-I), GH binding protein (GHBP) and IGF binding protein-3 (IGF-3); to determine the implications for fetal growth.
METHODS—Serum GH, IGF-I, GHBP and IGFBP-3 were measured in 53 fetuses, 41 aged 20-26 weeks (group A) and 12 aged 31-38 weeks (group B). Fetal blood samples were obtained by direct puncture of the umbilical vein in utero. Fetal blood samples were taken to rule out β thalassaemia, chromosome alterations, mother to fetus transmissible infections, and for maternal rhesus factor. GHBP was determined by gel filtration chromatography of serum incubated overnight with ¹²⁵I-GH. GH, IGF-I and IGFBP-3 were determined by radioimmunoassay.
RESULTS—Fetal serum GH concentrations in group A (median 29 µg/l, range 11-92) were significantly higher (P<0.01) than those of group B (median 16.7 µg/l, range 4.5-29). IGF-I in group A (median 20 µg/l, range 4.1-53.3) was significantly lower (P<0.01) than in group B (median 75.2 µg/l, range 27.8-122.3). Similarly, IGFBP-3 concentrations in group A (median 950 µg/l, range 580-1260) were significantly lower than those of group B (median 1920 µg/l, range 1070-1770). There was no significant difference between GHBP values in group A (median 8.6%, range 6.6-12.6) and group B (median 8.3%, range 6-14.3). Gestational age correlated positively with IGF-I concentrations (P<0.0001) and IGFBP-3 (P<0.0001) and negatively with GH (P<0.0001). GHBP values did not correlate with gestational age. Multiple regression analysis showed a negative correlation between GH:IGF-I ratio and fetal growth indices
CONCLUSIONS—The simultaneous evaluation of fetal GH, IGF-I, IGFBP-3 and GHBP suggests that the GH-IGF-I axis might already be functional in utero. The progressive improvement in the efficiency of this axis in the last part of gestation does not seem to be due to an increase in GH receptors.

     

Urinary excretion of epidermal growth factor and transforming growth factor-alpha in breast-fed and formula-fed infants

Urinary epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-α) concentrations were determined by radioimmunoassay in a longitudinal study analyzing 348 24-h urine specimens of 32 infants (16 breast-fed, 16 formula-fed) during the first 16 weeks of life. EGF excretion showed a statistically significant increase from 6.0 ±2.5 to 14.1±4.9 μg/g creatinine (mean± 1 SD) during the investigation period. TGF-α levels were fairly constant throughout this period. Comparing breast-fed infants, with more than 100-fold higher ingestion of EGF and TGF-α, with formula-fed infants, no significant differences in urinary EGF and TGF-α excretion were observed. These results do not rule out a systemic effect of EGF and TGF-α after intestinal absorption in breast-fed infants. The results suggest, however, that urinary EGF and TGF-α originate mainly from sources other than intestinal absorption.