特发性矮小症患儿治疗过程中血清IGF-1、IGFBP3水平变化趋势及与疗效的关系OA
The trend of changes in serum IGF-1 and IGFBP3 levels during the treatment of children with idiopathic short stature and their relationship with therapeutic efficacy
目的 探究特发性矮小症(ISS)患儿治疗过程中血清胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白3(IGFBP3)水平变化趋势及与疗效的关系.方法 选取2019年3月至2022年4月重庆市第五人民医院、重庆佑佑宝贝医院收治的120例ISS患儿为研究对象,接受重组人生长激素(rhGH)治疗.观察ISS患儿在治疗9个月过程中临床指标变化.建立预测ISS患儿身高增长满意度Logistic回归模型并验证模型.结果 治疗过程中,ISS患儿身高、体重、生长速度、预测成年身高、血清IGF-1、IGFBP3、克罗索蛋白(Klotho)、骨形态发生蛋白-2(BMP-2)、转录共刺激因子蛋白(TAZ)、25-羟维生素D[25(OH)D]及成纤维细胞生长因子23(FGF23)水平较治疗前明显提高,血清生长激素释放肽(Ghrelin)、细胞周期蛋白依赖性激酶抑制剂1A(p21 waf/cip1)水平均降低(F值介于5.073～94.362之间,P<0.05);主效应检验表明,增长满意组与增长不满意组患儿的时间效应、组间效应及交互效应差异均具有统计学意义(P<0.001);多因素Logistic回归模型显示年龄较大,IGF-1及IGFBP3水平较低,Ghrelin水平较高是影响ISS患儿身高增长的危险因素(OR值介于1.558～3.424之间,P<0.05),基础GH水平较低是影响ISS患儿身高增长的因素(OR=0.477,P<0.05).该模型预测准确度为90.39%,灵敏度为94.95%,特异度为84.82%,与ISS患儿身高增长满意度相比,曲线下面积(AUC)明显升高(0.875 vs.0.858,Z=12.172,P<0.01).结论 年龄、IGF-1、IGFBP3、基础GH及Ghrelin是影响特发性矮小症患儿身高增长的因素,这些指标可能有利于预估特发性矮小症患儿治疗的效果.
Objective To explore the trend of changes in serum insulin-like growth factor 1(IGF-1)and insulin-like growth factor binding protein 3(IGFBP3)levels during treatment in children with idiopathic short stature(ISS)and to analyze their relationship with therapeutic efficacy.Methods A total of 120 children with ISS who were admitted to The Fifth People's Hospital of Chongqing and Chongqing Youyou Baby Women and Children's Hospital between March 2019 and April 2022 were enrolled.All patients received recombinant human growth hormone(rhGH)therapy.Changes in clinical parameters were observed during the 9-month treatment period.A Logistic regression model was established to predict height gain satisfaction in children with ISS,and the model performance was subsequently validated.Results During treatment,height,weight,growth velocity(GV),predicted adult height,and serum levels of IGF-1,IGFBP3,Klotho,bone morphogenetic protein 2(BMP-2),transcriptional co-activator with PDZ-binding motif(TAZ),25-hydroxyvitamin D[25(OH)D],and fibroblast growth factor 23(FGF23)increased significantly compared with baseline,whereas serum levels of growth hormone releasing peptide(Ghrelin)and cyclin dependent kinase inhibitor 1A(p21 waf/cip1)decreased(F values ranged from 5.073 to 94.362,P<0.05).Main-effect analysis demonstrated that the time effect,group effect,and interaction effect differed significantly between the satisfactory growth group and the unsatisfactory growth group(P<0.001).Multivariate Logistic regression analysis revealed that older age,lower levels of IGF-1 and IGFBP3,and higher Ghrelin levels were risk factors for poor height gain in children with ISS(OR ranged from 1.558 to 3.424,P<0.05),whereas a lower baseline growth hormone(GH)level was identified as a protective factor(OR=0.477,P<0.05).The predictive model showed an accuracy of 90.39%,a sensitivity of 94.95%,and a specificity of 84.82%.Compared with height gain satisfaction in children with ISS,the area under the curve(AUC)was significantly increased(0.875 vs.0.858,Z=12.172,P<0.01).Conclusion Age,IGF-1,IGFBP3,baseline GH,and Ghrelin levels are important factors influencing height gain in children with idiopathic short stature.These indicators may be useful for predicting therapeutic efficacy in children with ISS.
杨帆;高敏;余春梅
重庆市第五人民医院儿科,重庆 400062重庆市第五人民医院儿科,重庆 400062重庆市第五人民医院儿科,重庆 400062
医药卫生
特发性矮小症治疗过程胰岛素样生长因子胰岛素样生长因子结合蛋白3变化趋势疗效
idiopathic short staturetreatment processinsulin-like growth factorinsulin-like growth factor binding protein 3trend of changeefficacy
《中国妇幼健康研究》 2026 (3)
8-15,8
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