Growth and pubertal development in transfusion-dependent children and adolescents with thalassaemia major and sickle cell disease: a comparative study

Despite regular blood transfusion and desferrioxamine treatment, growth impairment and pubertal delay are commonly seen in children and adolescents with transfusion-dependent thalassaemia and sickle cell disease (SCD). We evaluated growth parameters and sexual maturation in a large cohort of children and adolescents with SCD (n = 110) and thalassaemia (n = 72) receiving nearly the same protocol of transfusion and chelation, and compared them with those for 200 normal age-matched children, 30 children with constitutional delay of growth (CSS), and 25 children with growth hormone deficiency (GHD). Before transfusion, haemoglobin concentration had not been less than 9 g/dl in the past 7 years; desferrioxamine was administered for 7-10 years, including by the intramuscular and subcutaneous routes, three times or more per week. The height standard deviation score (HtSDS), growth velocity (GV) (cm/yr), and growth velocity standard deviation score (GVDSD) of children and adolescents with thalassaemia and SCD were significantly decreased compared to normal children (p < 0.01). Forty-nine per cent of thalassaemic patients and 27 per cent of patients with SCD had HtSDS less than -2, and 83 per cent of thalassaemic patients and 67 per cent of SCD patients had HtSDS less than -1. Fifty-six per cent of thalassaemic children and 51 per cent of children with SCD had GVSDS less than -1. The GV of thalassaemic children was significantly slower than that for children with SCD. Children with thalassaemia and SCD had HtSDS and GVSDS comparable to those for children with CSS but higher than those for patients with GHD. Serum ferritin concentration was correlated significantly with the linear GV in all patients (r = 0.45, p < 0.001). The bone age delay did not differ among the three groups with thalassaemia, SCD and CSS, but the delay was significant in the group with GHD. The mid-arm circumference was significantly smaller in children with thalassaemia and SCD than in normal children. The triceps skin-fold thickness of patients with SCD was significantly decreased compared to thalassaemic and normal children. The upper/lower segment ratio was significantly lower in thalassaemic and SCD patients than in normal children. In thalassaemic patients between the ages of 13 and 21 years a complete lack of pubescent changes was present in 73 per cent of boys and 42 per cent of girls. Seventy-four per cent of the thalassaemic girls had primary amenorrhoea. Girls with SCD aged between 13 and 21 years had markedly delayed breast development and menarche. Twenty-five per cent of boys with SCD above the age of 14 years had absence of testicular development. Males with thalassaemia and SCD who had spontaneous testicular development had significantly smaller testicular volume than did normal controls. Short children with thalassaemia and SCD had significantly decreased serum insulin-like growth factor 1 (IGF-1) concentrations compared to children with CSS. Collectively, these data confirm the high prevalence of impaired growth and pubertal delay/failure in children and adolescents with thalassaemia and SCD. The aetiology of impaired growth includes the contributions of lack of pubertal growth spurt due to delayed/absent puberty, decreased synthesis of IGF-1 which might be secondary to a disturbed GH-IGF-1 axis and/or under nutrition, probably due to the hypermetabolic status of these children. It is suggested that newer protocols of treatment, in addition to optimization of transfusion and chelation requirements, should increase the caloric intake of these patients and properly manage their pubertal delay-failure in order to improve their adult height.     

Relation of serum leptin and insulin-like growth factor-1 levels to intima-media thickness and functions of common carotid artery in children and adolescents with type 1 diabetes

BACKGROUND AND AIM: Leptin and insulin-like growth factor-1 (IGF-1) have been suggested to be involved in the pathogenesis of atherosclerosis. The aim of this study was to evaluate the relationship between serum leptin, IGF-1 and intima-media thickness (IMT) and functions of common carotid artery (CCA) in children and adolescent patients with type 1 diabetes. MATERIAL AND METHODS: Serum leptin and IGF-1 levels were measured in 45 diabetic patients (23 girls and 22 boys). Age, diabetes duration as well as major cardiovascular risk factors, including anthropometric and metabolic parameters, were matched between girls and boys. The relation of serum leptin and IGF-1 levels to CCA structure and functions were measured by ultrasonography as IMT, cross-sectional compliance (CSC), cross-sectional distensibility (CSD), diastolic wall stress (DWS) and incremental elastic modulus (IEM). RESULTS: Serum leptin levels of diabetic girls were higher than those in the boys (21.8 +/- 14.5 microg/l vs 8.9 +/- 10.6 micro/l, p = 0.002). However, the difference for serum IGF-I levels was not significant between diabetic girls and boys (240.7 +/- 96.8 ng/ml vs 234.7 +/- 93.2 ng/ml; p > 0.05). In all subjects, leptin levels were correlated with CSC (p = 0.04), CSD (p = 0.04) and IEM (p = 0.01), and IGF-1 levels were only correlated with CSC (p = 0.01). Leptin did not show any correlation with ultrasonographic measurements in both girls and boys separately. IGF-1 was correlated with CSC (p = 0.001), CSD (p = 0.002) and IEM (p < 0.001) in boys but not in girls. In a multivariate regression model, IGF-1 emerged as independent correlates for mean CSD and IEM in boys but not in girls. CONCLUSION: Serum leptin and IGF-1 levels in children and adolescent patients with type 1 diabetes are associated with functions of common carotid artery, and the association of IGF-1 levels is influenced by sex.     

Relationships Between Serum Free Fatty Acids and Zinc, and Attention Deficit Hyperactivity Disorder: A Research Note

The purpose of this study is to evaluate the relationships between serum free fatty acids (FFA) and zinc, and attention deficit hyperactivity disorder (ADHD). Forty eight children with ADHD (33 boys, 15 girls) were included in the patient group and 45 healthy volunteer children (30 boys, 15 girls) constituted the control group. The mean serum FFA level in the patient group was 0.176 ± 0.102 mEq/L and in control group, 0.562 ± 0.225 mEq/L ( p < .001). The mean serum zinc level of patient group was 60.6 ± 9.9 μg/dl and that of the control group. 105.8±13.2 μg/dl (p < .001). A statistically significant correlation was found between zinc and FFA levels in the ADHD group. These findings indicate that zinc deficiency may play a role in aetiopathogenesis of ADHD. Although we observed decreased FFA levels in ADHD cases, it is necessary to determine whether this condition is a principal cause of ADHD or is secondary to zinc deficiency.     

Effect of insulinlike growth factor-1 treatment in children with cystic fibrosis.

OBJECTIVES: Malnutrition is common in cystic fibrosis (CF) and adversely affects survival. Because insulinlike growth factor-1 (IGF-1) has insulinlike effects in terms of carbohydrate metabolism and is growth promoting, the authors hypothesized that its use would increase linear growth rate and decrease insulin requirements in children with CF. METHODS: The authors used a double-blind placebo-controlled crossover design. Seven prepubertal children aged 9.6 to 13 years (5 boys and 2 girls) were treated with placebo or IGF-1 for 6 months. After a 6-month washout period, patients received the alternative therapy for 6 months. The primary outcome measure was linear growth rate. Secondary outcome measures were changes in body mass index, body composition determined by dual energy x-ray absorptiometry, forced expiratory volume (FEV(1)), and the blood glucose/insulin ratio. RESULTS: The mean height z score at baseline was -1.5 +/- 0.8. At entry, the mean serum IGF-1 level was 124 +/- 25 ng/mL (normal range, 110-771 ng/mL). With treatment, mean serum IGF-1 levels increased twofold to threefold for all patients. The half-life for IGF-1 was 10.3 hours. We observed no significant difference in linear growth rate, weight gain, rate of accretion of lean body mass, or mean FEV(1) during treatment with IGF-1 compared with placebo. The glucose/insulin ratio, an indirect index of insulin sensitivity, was significantly increased with IGF-1 treatment compared with placebo ( P < 0.02). No adverse events related to IGF-1 were detected. CONCLUSIONS: Treatment with IGF-1 for 6 months did not promote linear growth in prepubertal children with CF. However, the glucose/insulin ratio was increased without changing blood glucose levels with IGF-1 treatment suggesting increased insulin sensitivity.     

Serum ghrelin levels in children with primary protein–energy malnutrition

Background: Ghrelin, an appetite-stimulating peptide, increases in cachectic conditions. It probably reflects peripheral nutritional status and influences nutrient intake and growth. The aim of the present study was to determine serum ghrelin levels in children with primary protein–energy malnutrition (PEM) and to find if any correlation exists between serum ghrelin levels and the clinical presentation of those patients.
Methods: Twenty-eight children with primary PEM and 10 healthy children were included. Serum fasting ghrelin levels were measured using radioimmunoassay.
Results: Mean serum ghrelin level of healthy children and those with PEM were 107.7 ± 40.1 pg/mL and 141.6 ± 123.8 pg/mL, respectively ( P  < 0.001). Ghrelin levels were independent of age and sex ( P  > 0.05). Ghrelin was negatively correlated with body mass index in healthy children ( P  < 0.01), but not in those with PEM ( P  > 0.05). Mean serum ghrelin level of children with moderate malnutrition was higher than that of children with severe malnutrition (199.2 ± 154.1 pg/mL vs 98.4 ± 74.3 pg/mL, P  < 0.05). Mean serum ghrelin levels of patients with kwashiorkor, marasmic kwashiorkor, and marasmus were 127.9 ± 97.8 pg/mL, 138.7 ± 95.8 pg/mL, and 162.3 ± 185.0 pg/mL, respectively ( P  > 0.05).
Conclusion: Serum ghrelin level is higher in patients with PEM, especially in those with marasmus, compared to healthy children. Although this observation suggests that ghrelin helps to fight malnutrition in children, it is obvious that further studies are needed to clarify the exact pathogenetic mechanism regarding this condition.     

孤独症谱系障碍儿童的血清胰岛素样生长因子-1和胰岛素样生长因子结合蛋白-3水平研究北大核心CSCD

目的探讨孤独症谱系障碍(autism spectrum disorder,ASD)儿童的血清胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)和胰岛素样生长因子结合蛋白-3(insulin-like growth factor binding protein-3,IGFBP-3)水平及与孤独症核心症状之间的关系。方法前瞻性选取重庆市妇幼保健院门诊招募的150名2~7岁ASD儿童和165名年龄、性别相匹配的正常健康儿童为研究对象,采用孤独症行为量表和孤独症评定量表评估ASD儿童核心症状,采用化学发光法检测两组儿童血清IGF-1和IGFBP-3水平。结果ASD组儿童血清IGF-1水平低于对照组儿童(P<0.05)。重度ASD儿童血清IGF-1和IGFBP-3水平低于轻-中度ASD儿童(P<0.001),2~3岁ASD儿童血清IGF-1水平低于对照组儿童(P<0.05)。两组男童IGF-1水平均低于女童(P<0.05)。血清IGF-1、IGFBP-3水平与儿童孤独症评定量表总分呈负相关(分别r=-0.32、-0.40,均P<0.001)。结论儿童早期血清IGF-1降低可能与ASD疾病发展相关,血清IGF-1和IGFBP-3水平与ASD儿童核心症状具有一定关联。     

Correlation of sex steroids with IGF-1 and IGFBP-3 during different pubertal stages

Insulin-like growth factor 1 (IGF-1) is the major factor that affects linear bone growth. Also, androgens and estrogens are necessary for increasing longitudinal bone growth during sexual maturation. The aim of this study was to investigate the relationships among IGF-1 axis and sex steroids during pubertal development in healthy adolescents. In this cross-sectional study, IGF-1, IGF binding protein-3 (IGFBP-3) and sex steroid levels (estradiol in girls, testosterone in boys) of 205 healthy adolescents (101 female, 104 male) aged 9-17 years were measured. All subjects were apparently healthy, with no growth retardation and with skeletal ages appropriate for chronological ages, and none were taking medications known to influence calcium homeostasis. Greulich and Pyle's Radiographic Atlas of Skeletal Development of the Hand and Wrist was used for determination of skeletal ages. Tanner's classification was used to determine the pubertal developmental stage. Fasting blood samples were obtained from subjects between 09:00-10:00 h. Serum IGF-1 and IGFBP-3 levels differed significantly between pubertal developmental stages. Serum IGF-1 levels and IGF-1/IGFBP-3 ratios increased with proceeding stages and maximum mean values were found at stages III-IV in girls and at stage IV in boys. Estradiol levels of girls and testosterone levels of boys differed significantly between stages, and in both sexes, serum IGF-1 levels and IGF-1/IGFBP-3 ratios were significantly correlated with sex steroid levels. Increase in growth hormone secretion increases IGF-1 levels. Furthermore, increasing sex steroids with pubertal development increase the IGF-1 levels and IGF-1/IGFBP-3 ratios that affect bone growth.     

Predicting and Monitoring of Growth in Children with Short Stature during the First Year of Growth Hormone Treatment

ABSTRACT. Fifteen prepubertal short stature children (10 girls, 5 boys), mean age 9.6 years (range 5.2–12.7 years), with normal response to growth hormone stimulation tests (group A) or partial growth hormone deficiency (GHD) of idiopathic nature (group B) were included in a controlled longitudinal study for evaluation of predictive parameters for the long-term growth response after administration of biosynthetic human growth hormone (B-hGH). The average knee–heel length velocity for the first 3 months was significantly correlated to total body height velocity during the following 9 months ( p <0.0008). By contrast, this association could not be found for height velocity during the same period. The increase in serum values of alkaline phosphatase and insulin-like growth factor I (IGF-1) during the first month of treatment was not significantly correlated to height velocity during the first year. During one year of treatment with B-hGH the mean height velocity for groups A and B increased from 4.4 cm/year (range 2.5–6.5) to 7.6 cm/year (range 4.7–10.6). Bone age advanced by 1.08 t0.60 per chronological year. The ratio between total height and knee-heel length prior to treatment was 3.34 ± 0.10 and after one year 3.33 ± 0.10, suggesting a proportional linear growth. An inverse relationship was observed between the ratio and chronological age. In conclusion, early knee–heel measurement may be a useful non-invasive predictor of long-term linear growth in children during treatment with growth hormone, and the ratio of total height to lower leg length may be of importance in detecting dysproportional growth.     

Blood pressure measurement in preschool children: The Hisayama study

Objective: To establish the blood pressure (BP) measurement protocol for Japanese preschool children, systolic BP (K1) and diastolic BP (K4, K5) were measured along with anthropometric values.
Methodology: Commercially available mercury sphygmomanometers were used. In the first group of children (group A), BP was measured in 79 boys and 85 girls using a cuff 9 cm wide and 23 cm long. In the second group (group B), the length and circumference of the upper right arm of 147 boys and 139 girls were measured to select cuffs appropriate for their sizes. Blood pressure measurements were performed twice on the right arm of the children in the seated position at a mean interval of 5 min.
Results: There were no significant differences in the anthropometric values (height, bodyweight, body mass index [BMI], length and circumference of the upper arm) between groups A and B. The BP values at K1, K4 and K5 in the first measurement of group B were 91 ± 9, 54 ± 8, and 48 ± 10 mmHg (boys) and 90 ± 9, 54 ± 8, and 48 ± 12 mmHg (girls), respectively. There were no significant differences between the first and second measurements in both groups, however, there were significant differences in the first and second measurements of K4 between groups A and B. Multiple regression analysis by the stepwise method revealed a strong correlation between K1 and the length of the upper arm in the boys and the bodyweight in the girls: between K4 and the bodyweight in the boys and the BMI in the girls, and between K5 and the height in the boys and the upper arm circumference in the girls.
Conclusions: From these results it would appear that a single measurement is sufficient under appropriate measurement conditions such as rest before measurement and the choice of the cuff size according to the upper arm circumference, and that BP is closely correlated with the anthropometric values in preschool children.     

Growth Hormone Treatment in Non-Growth Hormone-Deficient Children: Effects of Stopping Treatment

ABSTRACT. Overnight physiological growth hormone (GH) secretion was evaluated in 95 short, prepubertal children (73 boys, 22 girls). All the children were below the 3rd centile for height and achieved CH levels greater than 15 mU/1 following pharmacological stimulation. The mean average GH level was 7.1 mU/l and the mean sum of pulse amplitudes 80.4 mU/l. No relationship was found between age, height or height velocity and any of the parameters of GH secretion. The group was randomized to receive placebo, GH or remain under observation for the first 6 months and then all patients received GH treatment for a further 6 months. Those treated with GH, 0.27 IU/kg (0.1 mg/kg) three times weekly, in the first phase. demonstrated a mean increase in height velocity SDS of 3.24. There was no difference in growth response between the placebo or observation groups. In the second 6-month period. all children received GH according to the same dose regimen: they were then observed for a further 6 months following its discontinuation. In the 6 months following withdrawal of GH, all groups showed a significant fall in height velocity SDS, which returned to pretreatment levels, without demonstrating'catch-down'growth. Repeat sampling of overnight GH secretion within 3 days of discontinuing GH showed normal secretory patterns with a small reduction in mean peak amplitude. These results suggest that short children without classic GH insufficiency respond well to exogenous GH in the short term and return to pretreatment height velocities afterwards. Consequently, it may be possible to increase final adult height in such children by GH treatment.     

Adult height in children with prepubertal short stature secondary to intrauterine growth retardation

In a retrospective study of 47 children seen before puberty for growth retardation secondary to intrauterine growth retardation (IUGR), 23 boys had a final height of 161.9 ± 8.0 cm and 24 girls a final height of 147.6 ± 7.2 cm, values that were significantly lower than the target heights of these patients ( p < 0.001). This reduction in adult height indicates the possible usefulness of growth hormone therapy in children with IUGR.     

The role of insulin like growth factor (IGF) — 1 and IGF — binding protein-3 in diagnosis of Growth Hormone Deficiency in short stature children

Objective  The purpose of this study was to evaluate the role of IGF-1 and IGFBP-3 in diagnosis of short stature children and adolescents in whom Growth Hormone Deficiency (GHD) was found. Methods  In this cross sectional study the referred short stature children and adolescents to Namazi Hospital in Shiraz- Iran, in 2003–2005 were studied. The inclusion criteria were proved short stature based on the physical examination, weight, height, standard deviation score (SDS) of height < −2, with considering stage of puberty and predicted height in children without any genetic or chronic disorders. The exclusion criteria were any positive physical or laboratory data suggesting hypothyroidism, rickets or liver disorders. For all patients a provocative growth hormone test was performed with propranolol and L-dopa and serum IGF-1 and IGFBP-3 were measured. GHD defined as peak(cutoff) serum GH level under 10 ìg/L and low IGF-1 and IGFBP-3 considered as cutoff serum level under −2 standard deviation. Results  Eighty one short stature patients (39 boys and 42 girls) with mean age of 10.6 ± 3.5 years completed the study. Seventeen patients with GHD were found and in 18 patients IGF-1 level were low. Only in 6 patients both GH and IGF-1 were low and 2 of them had low IGFBP-3. There were no correlations between the levels of GH,IGF-1 and IGFBP-3 in children with short stature due to GHD. The sensitivity and specifity of IGF-1 and IGFBP-3 in assessment of GHD were 35% and 81% for IGF-1 and 12% and 94% for IGFBP-3, respectively. Conclusion  No correlations were found between GH level and serum levels of IGF-1 and IGFBP-3 in short patients and the sensitivity of those tests in assessment of GHD were poor.     

Growth hormone secretory dynamics in children with precocious puberty

We investigated whether an increase in growth hormone secretion contributed to the growth spurt in children with precocious puberty by measuring the 24-hour profile of serum growth hormone in 51 patients with central precocious puberty. Girls with central precocious puberty had significantly greater mean 24-hour levels of growth hormone in comparison with normal prepubertal girls (5.1 +/- 0.5 SEM vs 3.4 +/- 0.3 ng/mL, P less than 0.005). Mean 24-hour growth hormone levels did not differ significantly between boys with central precocious puberty and normal prepubertal boys (4.4 +/- 1.2 vs 3.0 +/- 0.4 ng/mL). Serum somatomedin C levels were significantly correlated with mean 24-hour growth hormone levels in the girls only. Height age advancement (expressed as height age/chronologic age) was significantly correlated with mean 24-hour growth hormone levels in both boys and girls with central precocious puberty. We conclude that spontaneous 24-hour growth hormone secretion in girls with precocious puberty is greater than that of normal prepubertal girls and may mediate at least in part the increased growth rate in this disorder.     

左向右分流型先天性心脏病合并心力衰竭患儿血清IGF-1和IGFBP-3的变化及意义

目的：探讨左向右分流型先天性心脏病（先心病）合并心力衰竭（心衰）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)的变化及意义。方法：20例健康儿童（对照组）,20例无心脏基础疾病的心衰患儿（心衰组）,20例无心衰的左向右分流型先心病患儿（先心组）,30例伴心衰的左向右分流型先心病患儿（先心+心衰组）作为研究对象。对不同组别的血清IGF-1及IGFBP-3进行比较;并对先心+心衰组患儿按心功能Ⅱ、Ⅲ、Ⅳ级分为3个亚组,对其血清IGF-1、IGFBP-3及cTnI水平进行比较及相关性分析。结果：先心组血清IGF-1及IGFBP-3水平下降,与对照组比较差异有统计学意义(P<0.01)。先心+心衰组血清IGF-1水平明显下降,与对照组及先心组比较差异有统计学意义(分别P<0.01,P<0.05)。心衰组血清IGF-1及IGFBP-3水平明显增高,与其他各组比较差异有统计学意义(P<0.01)。先心+心衰组患儿按心功能分级比较的各亚组间随心功能下降血清IGF-1水平依次降低(P<0.01),且该组患儿血清IGF-1、IGFBP-3水平与血清cTnI水平呈负相关（分别r=-0.692、-0.530,P<0.05）。结论：血清IGF-1水平可作为左向右分流型先心病病情评估的客观指标及合并心衰的危险因素,这也为该类患儿使用外源性IGF-1治疗心衰提供了临床依据。     

健康儿童血清性激素水平测定的意义

目的建立健康儿童血清性激素的正常参考值范围,评价健康儿童生长发育情况及判断儿童性早熟。方法收集462名健康儿童(年龄1个月~14岁;男257名,女205名)血清,应用化学发光方法分别测定其睾酮(T)和雌二醇(E2)水平,最终得出其分组正常值。结果1~12个月婴儿中E2在不同性别间无显著性差异,但T在不同性别间有显著差异。男童性发育落后于女童。男童青春前期和青春期E2测定结果年龄差异无显著性,T的测定结果年龄差异显著。结论随着检测方法的改进,健康儿童血清性激素正常参考值也在发生改变。建立T、E2正常参考值能更好地指导临床对性早熟的诊断。     

Physiological Growth Hormone Secretion and Response to Growth Hormone Treatment in Children with Short Stature and Intrauterine Growth Retardation

Stanhope, R., Ackland, F., Hamill, G., Clayton, J., Jones, J. and Preece, M.A. (Department of Growth and Development, Institute of Child Health, London and Serono Laboratories, UK). Physiological growth hormone secretion and response to growth hormone treatment in children with short stature and intrauterine growth retardation. Acta Paediatr Scand [Suppl] 349: 47, 1989.
Physiological growth hormone (GH) secretion was examined in 31 children (8 girls, 23 boys) with short stature secondary to intrauterine growth retardation (IUGR). Seventeen (4 girls, 13 boys) had dysmorphic features of Russell-Silver syndrome. Four of the 31 children had GH insufficiency with peak GH levels of < 20 mU/I during the night. Nine of the patients (8 of whom had Russell-Silver syndrome) had a single nocturnal GH pulse. Twenty-three children (6 girls, 17 boys) were randomized into two groups treated with either 15 or 30 U/m²/week of GH by daily subcutaneous injections. Age, sex distribution, pretreatment height velocity SD score (SDS), and distribution of dysmorphic and non-dysmorphic children were similar in both groups. The group treated with 15 U/m2/week for a mean of 0.82 years showed an increase in mean height velocity SDS from - 0.61 to +1.09, and the group treated with 30 U/m²/week for a mean of 0.92 years showed an increase in mean height velocity SDS from -0.69 to +3.48. The results suggest that physiological GH insufficiency is probably common in children with Russell-Silver syndrome and that both dysmorphic and non-dysmorphic children with short stature secondary to IUGR will respond to GH treatment. Initial evidence suggests that the increase in short-term growth velocity does not result in an improved final height prognosis.     

1~24月婴幼儿胰岛素样生长因子-1水平及与生长发育的关系

目的：分析1~24月龄婴幼儿血清胰岛素样生长因子-1（IGF-1）水平及其与生长发育的关系。方法：525名健康婴幼儿入选本研究（早产儿125名,足月儿400名）,测量体重/身长,酶联免疫吸附法检测血清IGF-1水平。结果：早产组婴儿期血清IGF-1水平在生后1.5月为最低（86±60 ng/mL）,此后一直维持较高水平,生后4~12月显著高于足月组。足月组婴儿期血清IGF-1水平在生后1.5月为最高(116±52 ng/mL),此后缓慢下降,生后8月时降至最低（69±58 ng/mL）。不论是早产儿还是足月儿体重/身长SDS与血清IGF-I水平均存在着正相关关系。结论：血清IGF-1水平均与婴幼儿期生长发育速度密切相关。［中国当代儿科杂志,2010,12（6）：459-461］     

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。     

Effects of oral zinc supplementation on zinc status and catch-up growth during the first 2 years of life in children with non-organic failure to thrive born preterm and at term

Background

We aimed to analyze the effect of oral zinc supplementation on serum insulin-like growth factor-1 (IGF-1) levels and catch-up growth in infants with non-organic failure to thrive (NOFTT) who were born preterm as compared to those born at term.

Growth and somatomedin responses to growth hormone in Down's syndrome.

Five growth retarded children with Down''s syndrome, three girls and two boys aged between 3 1/2 and 6 1/2 years with trisomy 21, were treated with human growth hormone for six months. Before treatment the growth hormone response to sleep and insulin-arginine load, as well as serum concentrations of insulin, thyroid hormones, and cortisol was found to be in the normal range. During the treatment with human growth hormone the growth velocity increased in all the children with Down''s syndrome from 2.3-2.8 cm to 3.3-5.8 cm per six months. The serum concentrations of immunoreactive insulin like growth factor 1 (IGF-1) were low before treatment and increased during the treatment with human growth hormone. The serum concentrations of immunoreactive insulin like growth factor 2 (IGF-2), which were within the normal range, however, increased during treatment with human growth hormone. Children with Down''s syndrome respond to treatment with human growth hormone, with an increase in both growth velocity and serum somatomedin concentrations.