Papastathi Chrysoula, Mavrommatis Antonis, Mentzelopoulos Spyros, Konstandelou Evangellia, Alevizaki Maria, Zakynthinos Spyros
First Department of Critical Care Medicine and Pulmonary Services, Medical School of Athens University, Evaggelismos Hospital, Athens, Greece.
Growth Horm IGF Res. 2013 Aug;23(4):98-104. doi: 10.1016/j.ghir.2013.03.005. Epub 2013 Apr 21.
To investigate the Growth Hormone (GH)/Insulin-like Growth Factor-I (IGF-I) axis and identify the factors that determine IGF-I levels in adult septic patients of variable severity, i.e., with sepsis, severe sepsis or septic shock, in the acute phase of disease.
In 107 consecutive septic patients (44 with sepsis, 13 with severe sepsis, and 50 with septic shock), GH, IGF-I, Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), insulin, cortisol, albumin, thyroid hormones, C-reactive protein and interleukin-6 serum levels were measured once within 48 h after onset of a septic episode. Twenty-nine healthy volunteers served as controls.
IGF-I and IGFBP-3 levels were decreased in patients with sepsis and severe sepsis (versus controls), decreasing further in patients with septic shock (versus sepsis). IGF-I levels were positively related to IGFBP-3, albumin, triiodothyronine and thyroxine, and inversely related to cortisol, sepsis severity, C-reactive protein, interleukin-6 and age. In multiple regression analysis, IGF-I levels were independently related to IGFBP-3 and albumin (lower in patients with decreased IGFBP-3 and albumin levels) (p<0.001 and p=0.01, respectively), and cortisol (lower in patients with increased cortisol levels) (p=0.04). IGFBP-3 accounted for most of the variance explained by the model (R(2)=0.519). GH levels were not related to IGF-I levels or mortality. IGF-I and IGFBP-3 levels were not associated with mortality.
The GH/IGF-I axis is severely disrupted in septic patients. IGFBP-3 is the major determinant of IGF-I levels.
研究生长激素（GH）/胰岛素样生长因子-I（IGF-I）轴，并确定在疾病急性期不同严重程度的成年脓毒症患者（即脓毒症、严重脓毒症或脓毒性休克患者）中决定IGF-I水平的因素。
对107例连续的脓毒症患者（44例脓毒症、13例严重脓毒症和50例脓毒性休克患者），在脓毒症发作后48小时内测量一次GH、IGF-I、胰岛素样生长因子结合蛋白-3（IGFBP-3）、胰岛素、皮质醇、白蛋白、甲状腺激素、C反应蛋白和白细胞介素-6的血清水平。29名健康志愿者作为对照。
脓毒症和严重脓毒症患者的IGF-I和IGFBP-3水平降低（与对照组相比），脓毒性休克患者的水平进一步降低（与脓毒症患者相比）。IGF-I水平与IGFBP-3、白蛋白、三碘甲状腺原氨酸和甲状腺素呈正相关，与皮质醇、脓毒症严重程度、C反应蛋白、白细胞介素-6和年龄呈负相关。在多元回归分析中，IGF-I水平与IGFBP-3和白蛋白独立相关（IGFBP-3和白蛋白水平降低的患者较低）（分别为p<0.001和p=0.01），与皮质醇相关（皮质醇水平升高的患者较低）（p=0.04）。IGFBP-3占模型解释的大部分方差（R(2)=0.519）。GH水平与IGF-I水平或死亡率无关。IGF-I和IGFBP-3水平与死亡率无关。
脓毒症患者的GH/IGF-I轴严重紊乱。IGFBP-3是IGF-I水平的主要决定因素。
