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

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63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±26.6) ng/ml，IGFBP-3为(2 756.1±763.8) ng/ml，与对照组［(103.9±46.5) ng/ml，(2 717.1±480.2 ng/ml)相比无统计学差异(P>0.05)；但青春期糖尿病患儿血IGF-I和IGFBP-3［(178.2±65.9) ng/ml，(2 956.0±847.6) ng/ml］均低于对照组［(229.6±54.5) ng/ml，(3 393.2±748.9) ng/ml］］P<0.05。②新发病的I型糖尿病患儿胰岛素治疗后血IGF-I为(143.0±67.5) ng/ml，IGFBP-3为(2 740.0±449.8) ng/ml，较治疗前［(54.8±44.3) ng/ml, (2 233.8±336.2) ng/ml］明显升高(P<0.05)。③糖尿病组HbA IC与血IGF-I，IGFBP-3之间存在负相关关系(r=-0.32，-0.29，P<0.01或0.05)。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，均高于青春期前［(7.8±1.8) %，(0.64±0.38) U/kg］(P<0.05)。结论：儿童Ⅰ型糖尿病血IGF-I，IGFBP-3水平较正常儿降低，尤其青春期患儿比正常同龄儿降低的程度更为显著，提示此类患者青春期存在GH IGF-I轴的严重紊乱，可能是导致这一时期血糖控制不良的重要原因。

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

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.