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目的探讨生长激素-胰岛素样生长因子(GH-IGF)轴在先天性心脏病患儿中的变化。方法2004年1~10月在广西医科大学一附院经超声心动图或手术确诊的先天性心脏病患儿50例,应用ELISA方法检测50例患儿及20名健康小儿血中生长激素结合蛋白(GHBP),应用免疫放射分析检测血中胰岛素样生长因子-1(IGF-1)及胰岛素样生长因子结合蛋白-3(IGFBP-3)。结果先天性心脏病患儿血清IGF-1、IGFBP-3质量浓度下降,有紫绀及心衰者下降更为显著;GHBP浓度在有紫绀及心功能不全的患儿中下降。结论先天性心脏病患儿GH-IGF轴发生紊乱,存在生长激素抵抗或不敏感。GHR下调可能是生长激素抵抗或不敏感的分子机制之一。

Changes of growth factor-insulin-like growth factor axis in the children with congenital heart disease

Objective To investigate the changes of growth hormone-insulin-like growth factor(GH-IGF) axis in the children with congenital heart disease (CHD).Methods Serum growth hormone binding protein (GHBP) was determined in 50 children with CHD and 20 normal children from Jan.2004 to Oct.2004 by enzyme-linked immunosorbent assay (ELISA); serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) were determined by immunoradiometric assay.Results The levels of serum IGF-1 and IGFBP-3 decreased in the patients with CHD; they were significantly decreased in the cyanotic group and heart failure group.The level of serum GHBP was decreased in the cyanotic group and heart failure group.Conclusion Cyanotic patients are the ones most severely affected.GH-IGF axis is disordered in the patients with CHD.It is suggested that reduced growth hormone receptor status represents one of the molecular mechanisms of GH insensitivity in the CHD.