Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, 400 012, Maharashtra, India.
Hepatol Int. 2009 Mar;3(1):305-9. doi: 10.1007/s12072-008-9102-1. Epub 2008 Sep 20.
Growth retardation has been described in patients with extrahepatic portal vein obstruction (EHPVO). An abnormal growth hormone (GH)-insulin-like growth factor (IGF) axis has been postulated as a possible etiology. We compared anthropometric parameters and IGF-1 and insulin-like growth factor binding protein-3 (IGFBP-3) levels in patients with EHPVO with their siblings as controls.
Consecutive patients diagnosed with EHPVO who presented to out-patient clinic in Department of Gastroenterology between February 2005 and February 2006 were enrolled along with their siblings whenever possible. After detailed history and clinical examination, anthropometric parameters such as age, height, weight, and mid-parental height were measured in patients and controls. IGF-1 and IGFBP-3 levels were also estimated.
Fifty-two patients (40 males, 32 adults) were enrolled. Sibling controls were available for 28 patients. Variceal bleeding was the presenting symptom in 41 of 52 (78.8%) patients. Target height was not achieved in 7 of 32 (22.6%) adults and 6 of 20 (30%) children, showing evidence of growth retardation. The mean IGF-1 levels in patients and controls were 124.71 +/- 65.49 ng/ml and 233 +/- 76.98 ng/ml (P < 0.01), respectively. The mean IGFBP-3 levels in patients and controls were 2.90 +/- 1.07 mug/ml and 4.22 +/- 0.77 mug/ml (P < 0.01), respectively. Hormonal levels between those with and without evidence of growth retardation did not differ significantly. Duration of symptoms, spleen size, platelet count, and age of presentation did not correlate with anthropometry and hormonal levels.
Growth retardation by anthropometry was documented in a quarter of patients with EHPVO. All patients had significantly low IGF-1 and IGFBP-3 levels in comparison with controls despite normal anthropometry in majority of patients (75%).
已描述过肝外门静脉阻塞（EHPVO）患者的生长迟缓现象。有人推测，异常的生长激素（GH）-胰岛素样生长因子（IGF）轴可能是其病因之一。我们将 EHPVO 患者与其兄弟姐妹（对照组）的人体测量参数和 IGF-1 及胰岛素样生长因子结合蛋白-3（IGFBP-3）水平进行了比较。
2005 年 2 月至 2006 年 2 月间，我们连续招募了在胃肠病科门诊就诊的 EHPVO 患者及其尽可能的兄弟姐妹作为研究对象。在详细询问病史和体格检查后，我们测量了患者和对照组的年龄、身高、体重和中亲身高。我们还估计了 IGF-1 和 IGFBP-3 水平。
共纳入 52 例患者（40 名男性，32 名成年患者）。28 例患者有兄弟姐妹对照组。52 例患者中，41 例（78.8%）以静脉曲张出血为首发症状。32 名成年患者中，7 名（22.6%）和 20 名儿童患者中 6 名（30%）未达到目标身高，表明存在生长迟缓。患者和对照组的 IGF-1 水平分别为 124.71 ± 65.49ng/ml 和 233 ± 76.98ng/ml（P < 0.01），IGFBP-3 水平分别为 2.90 ± 1.07μg/ml 和 4.22 ± 0.77μg/ml（P < 0.01）。有和无生长迟缓证据的患者之间的激素水平无显著差异。症状持续时间、脾脏大小、血小板计数和就诊年龄与人体测量和激素水平均无相关性。
我们发现四分之一的 EHPVO 患者存在人体测量法定义的生长迟缓。尽管大多数患者（75%）的人体测量值正常，但所有患者的 IGF-1 和 IGFBP-3 水平均明显低于对照组。
