矮小儿童血清生长激素胰岛素样生长因子-1及尿生长激素检测的临床意义

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(20：00~8：00)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/g Cr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/g Cr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 insulin like growth factor 1,serum growth hormone and urinary growth hormone measurement in short statured children.

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. MethodsFrom 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. ResultsAccording 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. ConclusionSerum IGF 1 and urinary GH levels have important significance in the diagnosis of short statured children.