强的松治疗对肾病综合征儿童血清IGF-Ⅰ及IGFBPs的影响

摘要

目的了解儿童肾病综合征(NS)及糖皮质激素(GC)治疗对血清胰岛素样生长因子-Ⅰ(IGF-Ⅰ)及其结合蛋白(IGFBPs)的影响.方法采用免疫放射法对36名NS患儿,即未治疗的活动期组(ANS,12例),强的松治疗中活动期组(GNS,12例)和缓解期组(RE,12例),进行了血清IGF-Ⅰ及其IGFBPs水平测定,并以同年龄组正常儿童作对照(NC,10例).结果 (1)与正常对照比较,NS活动期血清IGF-Ⅰ和IGFBP-3明显降低(P<0.01),而IGFBP-1和IGFBP-2均明显升高(P<0.01);(2)NS缓解期血清IGF-Ⅰ和IGFBP-3明显高于活动期 (P<0.01),而IGFBP-1和IGFBP-2明显低于活动期(P<0.01);(3)经激素治疗的活动期组血清IGF-Ⅰ和IGFBP-3均明显高于未治疗活动期组(P<0.01),IGFBP-1和IGFBP-2水平也明显低于ANS组(P<0.01);(4)NS活动期血清IGFBP-3与ALB成正相关(r=0.76,P<0.01),血清IGF-Ⅰ与IGFBP-3成正相关, 而与IGFBP-1、IGFBP-2成负相关.在缓解期及激素治疗中的活动期血清IGF-Ⅰ及IGFBPs与ALB及CHO没有相关关系.结论 1)儿童肾病综合征活动期血清IGF-Ⅰ和IGFBPs发生明显改变,这种改变在缓解期可恢复正常.2)糖皮质激素治疗对肾病综合征儿童血清IGF-Ⅰ和IGFBPs有明显影响.3)肾病综合征儿童生长障碍可能与血清IGF-Ⅰ和IGFBPs变化有关.%Objective To identify the changes in serum insulin like growth factor-Ⅰ (IGF-Ⅰ) and IGF binding proteins (IGFBPs) in children with nephrotic syndrome (NS) and the effect of glucocorticoid on serum IGF-Ⅰ and IGFBPs. Methods We measured serum IGF-Ⅰ and IGFBPs levels by radioimmune assay and immune radiomagnetic assay in 36 children with NS, consisting of an active stage group (ANS, n=12), a remission stage group (RE, n=12), an active stage group with glucocorticoid treatment (GNS, n=12), and a normal control group (NC, n=10). Results 1) Compared to NC, serum levels of IGF-Ⅰ and IGFBP-3 were decreased (P<0.01); serum levels of IGFBP-1 and IGFBP-2 were increased (P<0.01) in the ANS group. 2) Serum levels of IGF-Ⅰ and IGFBP-3 were higher and IGFBP-1 and IGFBP-2 were lower in the RE Group than in theANS Group (P<0.01). 3) Compared to the ANS group, serum levels of IGF-Ⅰ and IGFBP-3 were increased (P<0.01) and serum levels of IGFBP-1 and IGFBP-2 were decreased (P<0.01) in the GNS group. 4) A correlation was found between serum levels of IGFBP-3 and albumin in the active stage group (r=0.76, P<0.01). There was also a correlation between serum levels of IGF-Ⅰ and IGFBP-3 and an inverse correlation between the serum level of IGF-Ⅰ and serum levels of IGFBP-1 and IGFBP-2 in the ANS group. No other correlations were observed. Conclusions The serum levels of IGF-Ⅰ and IGFBPs are altered in children in the active stage of NS, but return to normal in the remission stage. GC treatment may influence serum IGF-Ⅰ and IGFBPs in children with NS. Changes in IGF-Ⅰ and IGFBPs levels may play a role in the growth retardation of NS children.