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目的:探讨胰岛素样生长因子-Ⅰ(IGF-Ⅰ)和胰岛素样生长因子结合蛋白-3(IGFBP-3)诊断矮小儿童生长激素缺乏的价值。方法:①对64例身材矮小患儿用精氨酸激发试验和左旋多巴激发试验检测其血清生长激素(GH)水平,两项药物激发试验GH峰值均<10ng/ml诊断为生长激素缺乏(GHD组,40例),其中有一项激发试验GH峰值>10ng/ml,即可确实诊断为特发性矮小症(ISS组,23例)。选取45例健康儿童作为对照组。②用化学发光法检测血清IGF-Ⅰ和IGFBP-3水平。结果:①血清IGF-Ⅰ水平,GHD组为(80.35±32.46)ng/ml,ISS组为(123.26±62.13)ng/ml,正常对照组为(362.20±78.21)ng/ml;血清IGFBP-3水平,GHD组为(2.67±1.32)ng/ml,ISS组为(3.62±1.524)ng/ml,正常对照组(6.39±1.06)ng/ml。②GHD组和ISS组患儿血清IGF-Ⅰ和IGFBP-3水平显著低于健康对照组(P<0.05);GHD组比ISS组患儿血清IGF-Ⅰ、IGFBP-3水平减低有显著性差异(P<0.05)。③按正常对照组x-2s作为临界值诊断GHD,IGF-Ⅰ的阳性率为95%;IGFBP-3的阳性率为92.5%;IGF-Ⅰ、IGFBP-3水平同时评价时,阳性率为87.50%。结论:IGF-Ⅰ、IGFBP-3检测可用于诊断身材矮小儿童的生长激素缺乏。
Objective: To investigate the value of insulin-like growth factor-Ⅰ (IGF-Ⅰ) and insulin-like growth factor binding protein-3 (IGFBP-3) in the diagnosis of growth hormone deficiency in short children. Methods: Sixty-four patients with short stature were tested for serum GH level by arginine provocation test and L-dopa challenge test. The peak GH levels of both drugs were all less than 10ng / ml, which were diagnosed as growth hormone deficiency GHD group, 40 cases). One of them had a GH test of> 10ng / ml, which could be confirmed as idiopathic short stature (ISS group, 23 cases). 45 healthy children were selected as the control group. ② using chemiluminescence detection of serum IGF-Ⅰ and IGFBP-3 levels. Results: Serum IGF-Ⅰ level was (80.35 ± 32.46) ng / ml in GHD group, (123.26 ± 62.13) ng / ml in ISS group and (362.20 ± 78.21) ng / ml in normal control group; (2.67 ± 1.32) ng / ml in GHD group, (3.62 ± 1.524) ng / ml in ISS group and 6.39 ± 1.06 ng / ml in normal control group. ② The levels of serum IGF-Ⅰ and IGFBP-3 in children with GHD and ISS were significantly lower than those in healthy controls (P <0.05); The serum IGF-Ⅰ and IGFBP-3 levels in children with GHD were significantly lower than those in ISS P <0.05). ③ The positive rate of IGF-Ⅰ was 95%, the positive rate of IGFBP-3 was 92.5%, while the positive rate of IGF-Ⅰ and IGFBP-3 was 87.50 %. Conclusion: IGF-Ⅰ, IGFBP-3 can be used to diagnose the growth hormone deficiency in short stature children.