Locuratolo N, Pugliese G, Pricci F, Romeo G, Mariani P, Diaz-Horta O, Calvani L, Montuori M, Cipolletta E, Di Mario U, Bonamico M
Second Institute of Internal Medicine, Chair of Endocrinology, 'La Sapienza' University, Rome, Italy.
Diabetes Metab Res Rev. 1999 Jul-Aug;15(4):254-60. doi: 10.1002/(sici)1520-7560(199907/08)15:4<254::aid-dmrr47>3.0.co;2-f.
Chronic undernutrition resulting from coeliac disease (CD) could be associated with changes in the circulating insulin-like growth factor (IGF) system, which may participate in the pathogenesis of growth retardation occurring in these patients.
We performed a cross-sectional study in CD subjects attempting to (1) document the pattern of serum IGF-I and IGF binding protein (IGFBP) 1 and 3 at diagnosis and (2) assess the response of circulating IGF system to dietary treatments, in comparison with the response of clinical and laboratory findings utilized for the diagnosis of CD. Thirty-two prepubertal CD children were divided into three groups based on the dietetic treatment: at diagnosis (D, n=18); on gluten-free diet for at least 6 months (GFD, n=7); and on gluten challenge for at least 3 months (CH, n=7). Six postpubertal CD patients were also studied at diagnosis.
In prepubertal children IGF-I levels were significantly reduced (by 29%) in D vs sex- and age-matched normal control (NC) subjects, with reductions being more pronounced before 3 years of age. Likewise, serum IGFBP-3 concentrations were decreased by 22%, whereas circulating IGFBP-1 levels were increased by 60%, compared with NC, with more marked IGFBP changes in older children. Similar alterations were observed in postpubertal patients. Changes in the circulating IGF system disappeared in GFD subjects and reappeared in CH children, as positivity of disease-specific antibodies. Body mass index (BMI) also improved in GFD subjects, but did not decrease in CH children. Changes in IGF-I and IGFBPs did not correlate with each other. Levels of IGF-I, but not of IGFBPs, maintained the relation with age and correlated significantly with BMI and positivity of antibodies.
These results demonstrate that CD patients show significant changes in serum IGF-I, in younger children, and IGFBPs (particularly IGFBP-1), in older children and adolescents, correlating with clinical course and response to dietary treatments. The alteration in the circulating IGF system could be implicated in the pathogenesis of growth retardation occurring in CD and may provide an additional tool in monitoring of the disease.
乳糜泻（CD）导致的慢性营养不良可能与循环胰岛素样生长因子（IGF）系统的变化有关，该系统可能参与这些患者生长发育迟缓的发病机制。
我们对CD患者进行了一项横断面研究，旨在（1）记录诊断时血清IGF-I、IGF结合蛋白（IGFBP）1和3的模式，以及（2）与用于诊断CD的临床和实验室检查结果的反应相比，评估循环IGF系统对饮食治疗的反应。32名青春期前CD儿童根据饮食治疗分为三组：诊断时（D组，n = 18）；接受无麸质饮食至少6个月（GFD组，n = 7）；接受麸质激发试验至少3个月（CH组，n = 7）。6名青春期后CD患者在诊断时也进行了研究。
在青春期前儿童中，与性别和年龄匹配的正常对照（NC）受试者相比，D组的IGF-I水平显著降低（降低29%），在3岁之前降低更为明显。同样，与NC组相比，血清IGFBP-3浓度降低了22%，而循环IGFBP-1水平升高了60%，年龄较大的儿童IGFBP变化更为明显。在青春期后患者中也观察到类似的变化。循环IGF系统的变化在GFD组受试者中消失，在CH组儿童中再次出现，如同疾病特异性抗体的阳性情况。GFD组受试者的体重指数（BMI）也有所改善，但CH组儿童的BMI没有下降。IGF-I和IGFBPs的变化彼此不相关。IGF-I水平（而非IGFBPs水平）与年龄保持关系，并与BMI和抗体阳性显著相关。
这些结果表明，CD患者在年幼时血清IGF-I有显著变化，在年长儿童和青少年中IGFBPs（特别是IGFBP-1）有显著变化，这与临床病程和饮食治疗反应相关。循环IGF系统的改变可能与CD患者生长发育迟缓的发病机制有关，并可能为疾病监测提供额外的工具。
