在评估接受恶性肿瘤治疗的儿童时，将胰岛素样生长因子-I（IGF-I）和胰岛素样生长因子结合蛋白-3（IGFBP-3）浓度与刺激后的生长激素（GH）进行比较。

Insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 (IGFBP-3) concentrations compared to stimulated growth hormone (GH) in the evaluation of children treated for malignancy.

作者信息

Cicognani A, Cacciari E, Pession A, Pasini A, De Iasio R, Gennari M, Alvisi P, Pirazzoli P

机构信息

Department of Pediatrics, University of Bologna, Italy.

出版信息

J Pediatr Endocrinol Metab. 1999 Sep-Oct;12(5):629-38. doi: 10.1515/jpem.1999.12.5.629.

DOI:10.1515/jpem.1999.12.5.629

PMID:10703534

Abstract

OBJECTIVE

The aim of this investigation was to evaluate the utility of IGF-I and IGFBP-3 determinations in screening for GH deficiency (GHD) in children previously submitted to treatment for childhood malignancy.

PATIENTS AND METHODS

We compared the GH responses to two pharmacological tests (arginine and levo-dopa) with the IGF-I and IGFBP-3 levels in 48 patients (29 boys) who had undergone bone marrow transplantation (BMT) (36 patients) or treatment for a solid cranial tumor (12 patients).

RESULTS

22 patients (45.8%) showed GHD (i.e. GH peak < 8 ng/ml in both tests), and only three (13.6%) of the GHD patients had concomitant low IGF-I levels (i.e. -2 SD below the normal mean) and only one (4.5%) an abnormal IGFBP-3 value (i.e. -2 SD below the normal mean). Among the 26 children with normal GH secretion, 21 (80.8%) also showed normal IGF-I and IGFBP-3 levels, three (11.5%) had a concomitant low IGF-I value and two (7.7%) a concomitant low IGFBP-3 value. A significant correlation was found between GH secretion and age at diagnosis (r = 0.26, P < 0.05), and between IGF-I and IGFBP-3 (r = 0.52, P < 0.0001), but not between GH and IGF-I or IGFBP-3. Comparing the growth pattern of these patients from diagnosis to the first year after therapy or BMT, we found that while individual height changes did not correlate with the GH peak, a significant correlation was found between height SDS decrease and IGF-I (r = 0.31, P < 0.05) or IGFBP-3 SDS (r = 0.37, P < 0.01).

CONCLUSION

Our results indicate that the cut-off of -2 SD for IGF-I and IGFBP-3 was insensitive in screening for GHD. A normal value did not exclude a subnormal GH response to provocative tests and therefore although IGF-I and IGFBP-3 levels may be indicators of the growth pattern, they cannot be used alone as a tool for identifying GHD children after treatment for childhood malignancy.

摘要

目的

本研究旨在评估胰岛素样生长因子-I（IGF-I）和胰岛素样生长因子结合蛋白-3（IGFBP-3）测定在筛查曾接受儿童恶性肿瘤治疗的儿童生长激素缺乏症（GHD）中的作用。

患者与方法

我们比较了48例患者（29例男孩）在接受骨髓移植（BMT）（36例患者）或实体颅咽管瘤治疗（12例患者）后，生长激素对两种药物激发试验（精氨酸和左旋多巴）的反应以及IGF-I和IGFBP-3水平。

结果

22例患者（45.8%）表现为生长激素缺乏症（即两种试验中生长激素峰值均<8 ng/ml），其中只有3例（13.6%）生长激素缺乏症患者同时伴有低IGF-I水平（即低于正常均值-2标准差），只有1例（4.5%）IGFBP-3值异常（即低于正常均值-2标准差）。在26例生长激素分泌正常的儿童中，21例（80.8%）IGF-I和IGFBP-3水平也正常，3例（11.5%）伴有低IGF-I值，2例（7.7%）伴有低IGFBP-3值。发现生长激素分泌与诊断时年龄之间存在显著相关性（r = 0.26，P < 0.05），IGF-I与IGFBP-3之间也存在显著相关性（r = 0.52，P < 0.0001），但生长激素与IGF-I或IGFBP-3之间无相关性。比较这些患者从诊断到治疗或BMT后第一年的生长模式，我们发现虽然个体身高变化与生长激素峰值无相关性，但身高标准差降低与IGF-I（r = 0.31，P < 0.05）或IGFBP-3标准差（r = 0.37，P < 0.01）之间存在显著相关性。