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目的研究重型病毒性肝炎患者ＧＨ－ＩＧＦ轴的变化及其临床意义。方法重型病毒性肝炎患者１８例，其中急性重型２例，亚急性重型５例，慢性重型１１例；正常对照２０例。ＥＬＩＳＡ法测定血清ＧＨ、ＩＧＦ－１、ＩＧＦＢＰ１及ＩＧＦＢＰ３，全自动生物化学分析仪常规方法测定肝脏生物化学指标。结果重型肝炎患者血清ＩＧＦ－１、ＩＧＦＢＰ３水平明显降低 ［（５．５± ６．２）μｇ／ｍｌ对 （１７ ±７０）μｇ／ｍｌ， （２．４±１．３） μｇ／ｍｌ对（９．４± １．７）， Ｐ＜ ０．００１］。 ＧＨ、ＩＧＦＢＰ１水平增高［（９．１±１２．４）ｎｇ／ｍｌ对（１６±２．４）ｎｇ／ｍｌ，Ｐ＜０．０５；（６７９±５０．２）ｎｇ／ｍｌ对（４５．８±３３．ｌ）ｎｇ／ｍｌ， Ｐ＜０．０１）］。血清ＩＧＦ－１与ＩＧＦＢＰ３呈正相关（ｒ＝０．９１， Ｐ＜０．００１）； ＩＧＦ－１降低与重型肝炎患者预后密切相关（Ｐ＜０．００１）。ＩＧＦ－１＜１０μｇ／ｍｌ，预测死亡的符合率为９０％；ＩＧＦ－１＞１０μｇ／ｍｌ，预测存活的符合率为８９．５％。结论重型病毒性肝炎患者ＧＨ－ＩＧＦ轴发生显著异常变化，ＧＨ增高与ＩＧＦ－１水平降低相矛盾，提示重型病毒性肝炎患者存在生长激素抵抗
Objective To study the changes of GH-IGF axis in patients with severe viral hepatitis and its clinical significance. Methods 18 cases of patients with severe viral hepatitis, including 2 cases of acute severe cases, 5 cases of subacute heavy and 11 cases of chronic severe and 20 cases of normal control. Serum GH, IGF-1, IGFBP1 and IGFBP3 were measured by ELISA, and biochemical indexes of liver were determined by the routine method of automatic biochemical analyzer. Results Serum levels of IGF-1 and IGFBP3 in patients with severe hepatitis were significantly lower than those in patients with severe hepatitis [(5.5 ± 6.2) μg / ml vs (17 ± 70) μg / ml vs (2.4 ± 1.3) μg / 9.4 ± 1.7), P <0.001]. The levels of GH and IGFBP1 were significantly higher than those of controls ([9.1 ± 12.4] ng / ml vs (16 ± 2.4) ng / ml, P <0.05; 8 ± 33.l) ng / ml, P <0.01)]. Serum IGF-1 was positively correlated with IGFBP3 (r = 0.91, P <0.001). The decrease of IGF-1 was closely related to the prognosis of patients with severe hepatitis (P <0.001). IGF-1 <10μg / ml, the predicted mortality rate was 90%; IGF-1> 10μg / ml, the predicted survival rate was 89.5%. Conclusions The GH-IGF axis of patients with severe viral hepatitis has significant abnormal changes. The increase of GH is contradictory with the decrease of IGF-1 level, suggesting that there is growth hormone resistance in patients with severe viral hepatitis