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目的探讨血清生长激素(GH)、胰岛素样生长因子-1(IGF-1)及尿GH检测对矮小儿童诊断的意义。方法华中科技大学同济医院儿科于2004-11—2005-06对106例矮小儿童进行垂体功能复合刺激试验,试验前收集所有受试者夜间12h(2000~800)尿。另选取19例正常青春发育期前儿童为对照组。对垂体功能复合刺激试验GH分泌异常的56例矮小儿童,用ELISA方法检测相应的血清GH、IGF-1及尿中GH水平,并进行相关分析。结果根据垂体功能复合刺激试验的GH检测结果将矮小儿分类,包括完全性GH缺乏症(cGHD)25例、部分性GH缺乏症(pGHD)9例和GH神经分泌功能障碍(GHND)22例。GHD组患儿血清IGF-1、尿GH水平与正常儿相比明显降低(P<0·01)。pGHD和GHND组患儿血IGF-1水平波动较大,无统计学差异。GHND组患儿尿GH水平按ng/g肌酐(Cr)计量显著低于正常对照相(P<0·05),而按ng/12h尿量计算值虽低于正常组,但无统计学意义(P>0·05)。pGHD组患儿尿GH水平按两种方法计量值均介于正常和GHD患者之间,与正常及GHD患者比较均有显著性差异(P均<0·05)。cGHD和pGHD组患儿尿GH的ng/gCr计量值与其血GH峰值呈显著性正相关(rcGHD=0·556,P<0·05;rpGHD=0·423,P<0·05),GHND组患儿尿GH的ng/gCr计量值与其血中GH峰值无相关性(P>0·05)。结论尿GH水平测定无创、简便,配合IGF-1等指标的检测,对于矮小儿童的诊断和鉴别诊断具有重要意义。

Clinical value of serum insultn-like growth factor 1, serum growth hormone and urinary growth hormone measurement in short-statured children

Objective To investigate the significance of serum growth hormone,serum insulin-like growth factor-1(IGF-1) and urinary growth hormone(GH)levels in the diagnosis of short statured children.Methods From Nov.2004-Jun.2005 to 106 short statured children and 19 normal children in prepuberty were selected,each having 12h (8:00pm~8:00AM) urine collection.The short statured children were given combined pituitary hormone provocating tests,and the corresponding serum GH,IGF-1 and urinary GH were determined by ELISA kits.Results According to the serum GH levels of provocating tests,the short-statured children were divided into three groups:complete growth hormone deficiency (cGHD) 25 cases,partial growth hormone deficiency(pGHD) 9 cases,disorders of growth hormone neurosecretion (GHND) 22 cases.IGF-1 and urinary GH in cGHD groups were remarkably lower than those in normal children( P <0.01).IGF-1 value of pGHD and GHND group fluctuated comparatively greatly,so there was no statistical significance compared to normal children.Urinary GH pg/mg creatinine(Cr)count in GHND group had significant difference vs.normal group( P <0.05), although urinary GH ng/12h count value was lower than normal group,there is no statistical significance( P >0.05).The two kinds of urinary GH in pGHD group were between normal and cGHD,and there was predominant difference vs.normal group ( P mean <0.05).Urinary GH pg/mg Cr count in cGHD and pGHD groups were positively correlated with the serum GH peak (rcGHD=0.556, P <0.05; rpGHD=0.423, P <0.05),respectively.Conclusion Serum IGF-1 and urinary GH levels have important significance in the diagnosis of short statured children.