生长激素-胰岛素样生长因子 1 轴在炎症性肠病和生长迟缓患儿中的作用。

The growth hormone insulin-like growth factor 1 axis in children and adolescents with inflammatory bowel disease and growth retardation.

机构信息

Bone and Endocrine Research Group, Royal Hospital for Sick Children, Glasgow, UK.

出版信息

Clin Endocrinol (Oxf). 2010 Aug;73(2):220-8. doi: 10.1111/j.1365-2265.2010.03799.x. Epub 2010 Feb 23.

DOI:10.1111/j.1365-2265.2010.03799.x

PMID:20184596

Abstract

CONTEXT

There is scarce knowledge about the growth hormone (GH) insulin-like growth factor-1 (IGF1) axis in children & adolescents with inflammatory bowel disease (IBD) and growth retardation.

OBJECTIVE

To describe the pattern of GH and IGF1 secretion in children & adolescents with IBD.

DESIGN

A retrospective review of 28 patients (23 M) of IBD (25 Crohn's Disease and three Ulcerative Colitis) and growth retardation who had investigation of the GH/IGF-1 axis. Height velocity (HV) and serum IGF1 were converted to standard deviation score (SDS); to account for delayed puberty in girls over 11 years and boys over 12 years, HV and serum IGF1 SDS were adjusted for bone age.

RESULTS

Median (range) age and Ht SDS at the time of endocrine evaluation was 14.3 years (7.7,17.0) and -2.0(-3.6,-0.9), respectively. Median HVSDS over the prior 12 months was -2.2(-7.7,2.8). Median peak serum GH on insulin tolerance test (ITT) was 5.8 mcg/l (1.3, 24.0), and median serum IGF1 SDS was -0.9(-3.1, 0.1). Five of 28 (18%) had a peak serum GH of >12 mcg/l. Overall, four had biochemical evidence of functional GH deficiency (peak GH < 3 mcg/l and IGF1 SDS < 0) and 11 children had biochemical evidence suggesting GH resistance (peak GH > 6 mcg/l and IGF1 SDS < 0). However, only one child had a peak serum GH > 6 mcg/l and a very low IGF1 SDS of <-2.0. There was a negative association between peak serum GH and Ht SDS (r = -0.49, P = 0.008), but there was no association with HV and there was no association between IGF1 SDS and Ht or HV SDS. IGF1 SDS showed a negative association with erythrocyte sedimentation rate (r = -0.41, P = 0.04).

CONCLUSION

Growth retardation in children and adolescents with IBD is commonly associated with a range of biochemical abnormalities ranging from functional GH deficiency to GH resistance. In these children, poor relationship between systemic markers of growth and height velocity point to an important role of growth factors at the target organ level in modulating growth in children with IBD. The value of assessing the GH/IGF-1 axis and whether it predicts subsequent response to growth-promoting therapy requires further exploration.

摘要

背景

关于炎症性肠病（IBD）和生长迟缓儿童青少年的生长激素（GH）-胰岛素样生长因子-1（IGF1）轴知之甚少。

目的

描述 IBD 儿童青少年的 GH 和 IGF1 分泌模式。

设计

对 28 例（23 例男性）IBD（25 例克罗恩病和 3 例溃疡性结肠炎）和生长迟缓患者的 GH/IGF-1 轴进行回顾性分析。身高速度（HV）和血清 IGF1 转换为标准偏差评分（SDS）；为了考虑 11 岁以上女孩和 12 岁以上男孩的青春期延迟，HV 和血清 IGF1 SDS 要根据骨龄进行调整。

结果

内分泌评估时的中位（范围）年龄和 Ht SDS 分别为 14.3 岁（7.7，17.0）和-2.0（-3.6，-0.9）。过去 12 个月的 HV SDS 中位数为-2.2（-7.7，2.8）。胰岛素耐量试验（ITT）时的中位血清 GH 峰值为 5.8 mcg/L（1.3，24.0），中位血清 IGF1 SDS 为-0.9（-3.1，0.1）。28 例中有 5 例（18%）的血清 GH 峰值>12 mcg/L。总体而言，有 4 例有功能性 GH 缺乏的生化证据（GH 峰值<3 mcg/L 和 IGF1 SDS<0），有 11 例儿童有 GH 抵抗的生化证据（GH 峰值>6 mcg/L 和 IGF1 SDS<0）。然而，只有 1 例儿童的血清 GH 峰值>6 mcg/L，而 IGF1 SDS 非常低，<-2.0。GH 峰值与 Ht SDS 呈负相关（r = -0.49，P = 0.008），但与 HV 无相关性，IGF1 SDS 与 Ht 或 HV SDS 也无相关性。IGF1 SDS 与红细胞沉降率呈负相关（r = -0.41，P = 0.04）。