难治性肾病综合征患儿生长激素-胰岛素样生长因子轴的变化及意义

目的：观察难治性肾病综合征(RNS)患儿生长激素(GH)-胰岛素样生长因子(IGF)轴的变化及意义。方法：计算26例RNS患儿的身高标准差积分(HtSDS)，以双抗放射免疫法和免疫放射法检测血、尿IGFI及其结合蛋白3(IGFBP3)水平和血GH基础值，以同年龄组正常儿童(NC组，n=18)作对照。结果：RNS组血IGFI(152.68±120.95) ng/ml，IGFBP3(2 183.33±1 711.33) ng/ml低于NC组(255.68±46.92) ng/ml，(4 333.87±1 122.00) ng/ml，(P<0.05)，尿IGFI(5.32±2.84) ng/mg肌酐，IGFBP3(16.38±8.55) ng/mg肌酐高于NC组(0.90±0.37) ng/mg肌酐，(5.13±1.64) ng/mg肌酐，(P<0.05)；RNS组的血GH水平虽低于NC组，但P>0.05。RNS组身高标准差积分(HtSDS)(-0.42±0.75)低于NC组(0.30±0.17)，(P<0.05)。结论：RNS患儿存在GHIGF轴的变化，此变化为RNS患儿生长障碍的主要原因之一。

Variation of GH2IGF Axis in Children with the Refractory Nephrotic Syndrome

Objective　To observe the variation of GH-IGF axis in children with the refractory nephrotic syndrome (RNS). Methods　Serum and urine levels of IGF-I and IGFBP-3 and baseline serum levels of GH were assayed using RIA and IRMA in 26 patients with RNS, and hight standard deviation score (HtSDS) was calculated. Eighteen healthy children of similar ages were used as the control group (NC group). Results　Serum IGF-I ［(152.68±120.95) ng/ml］ and IGFBP-3 ［(2 183.33±1 711.33) ng/ml］ levels in the RNS group were significantly lower than those of the NC group ［(255.68±46.92) ng/ml, 4 333.87±1 122.00) ng/ml］ (P<0.05), and urine IGF-I ［(5.32±2.84) ng/mg creatinine］ and IGFBP-3 ［(16.38±8.55) ng/mg creatinine］ levels were higher than those of the NC group ［(0.90±0.37) ng/mg creatinine, (5.13±1.64) ng/mg creatinine］ (P<0.05). The serum GH level was lower than that of the NC group, but didn't achieve any statistical significance. HtSDS (-0.42±0.75) of the RNS group was lower than that of the NC group (0.30±0.17)(P<0.05). Conclusions　A disorder of the GH-IGF axis was detected in children with RNS. This abnormality may contribute to the growth failure seen in RNS.