Powell D R
Clinical Care Center, Texas Children's Hospital, Houston 77030, USA.
J Pediatr. 1997 Jul;131(1 Pt 2):S13-6. doi: 10.1016/s0022-3476(97)70003-9.
Children with chronic renal failure (CRF) often have retarded growth, and abnormalities of the growth hormone-insulin-like growth factor (GH-IGF) axis in CRF may contribute to this growth failure. The serum GH and IGF levels are normal in these children, but IGF bioactivity is low as a result of excess IGF binding proteins (IGFBPs) in the 35 kd serum fractions. The levels of intact IGFBP-1, -2, and -6 and of a 29 kd IGFBP-3 fragment are all high, and the IGFBP-1 and -2 levels correlate negatively with height. Children with CRF who are treated with GH show catch-up growth that correlates positively with the increase in each component of the 150 kd serum ternary complex (acid-labile subunit, IGFBP-3, IGF-I, and IGF-II). Consistent with this observation, the increase in IGFBP-3 levels is confined to the 150 kd serum fractions. Serum levels of IGFBP-1, -2, and -6 do not rise, but serum IGF bioactivity does. Thus GH appears to induce an increase in the ternary complex in the serum of children with CRF. It is possible that IGFs released by the 150 kd serum complex promote growth by overcoming the inhibitory effects of excess IGFBPs in the 35 kd serum fractions.
慢性肾衰竭（CRF）患儿常出现生长发育迟缓，CRF中生长激素 - 胰岛素样生长因子（GH - IGF）轴异常可能导致这种生长障碍。这些患儿的血清GH和IGF水平正常，但由于35kd血清组分中存在过量的IGF结合蛋白（IGFBPs），IGF生物活性较低。完整的IGFBP - 1、-2和-6以及29kd的IGFBP - 3片段水平均升高，且IGFBP - 1和-2水平与身高呈负相关。接受GH治疗的CRF患儿出现追赶生长，且与150kd血清三元复合物（酸不稳定亚基、IGFBP - 3、IGF - I和IGF - II）各组分的增加呈正相关。与此观察结果一致，IGFBP - 3水平的升高仅限于150kd血清组分。血清IGFBP - 1、-2和-6水平未升高，但血清IGF生物活性升高。因此，GH似乎可诱导CRF患儿血清中三元复合物增加。150kd血清复合物释放的IGF可能通过克服35kd血清组分中过量IGFBPs的抑制作用来促进生长。
