糖尿病患者血清IGF-Ⅰ、IGF-Ⅱ、GH水平與骨質(zhì)疏松的關(guān)系

1、糖尿病患者血清IGF-、IGF-、GH水平與骨質(zhì)疏松的關(guān)系摘要目的探討人類(主要為糖尿病患者)血清胰島素樣生長(zhǎng)因子(IGF)、生長(zhǎng)激素(GH)與骨質(zhì)疏松發(fā)生發(fā)展的關(guān)系。方法通過(guò)對(duì)不同年齡階段的51例糖尿病患者與40例對(duì)照組的BMI、IGF、GH、血糖、BD、Ca、P等值的測(cè)定，進(jìn)行對(duì)照、比較、研究。結(jié)果糖尿病患者隨年齡的增長(zhǎng)、血糖的升高、BMI的增加、GH水平的降低、IGF-的分泌水平的減少、骨骼的BD、Ca、P等值降低，骨質(zhì)疏松發(fā)生率增加。結(jié)論IGF是人類重要而又作用廣泛的內(nèi)分泌因素之一，它不僅具有促細(xì)胞分化、增殖活性及胰島素樣作用，與糖尿病關(guān)系密切。而且對(duì)成骨細(xì)胞、破骨細(xì)胞即骨質(zhì)疏松的發(fā)生

2、、發(fā)展起一定作用。糖尿病病人存在骨代謝障礙即骨質(zhì)疏松，血中IGF、GH水平減少的容易導(dǎo)致骨質(zhì)疏松發(fā)生。關(guān)鍵詞糖尿病胰島素樣生長(zhǎng)因子生長(zhǎng)激素骨質(zhì)疏松 Relationship betweenlevels of IGF-1,IGF-11,GH in serum of patients with diabetes mellitus and osteoporosisShi Xiuqin, Su Yan,Yue lu,et al.Department of Endocrinology,First Harbin City Hospntal,Harbin 150010,ChinaAbstract Objec

3、tive To elucidate the relationship between insulin-like growth factor (IGF), growth hormone(GH) and osteoporosis.Methods Comparison was made between 51 diabetic patients and 40 normal controls in levels of BMI(body mass index),IGF,GH BG(blood glucose,fasting and postcibal),BD, Ca and P.Results Preva

4、lence of osteoporosis in diabetic patients rose with increasing age,BG and BMI,and with decreasing levels of GH,IGF-1,BD,Ca and P.Conclusion IGF influcences bone turnover disease and osteoporosis in patients with diabetes mellitus,and there is significant correlation between decreased IGF,GH levels

5、in blood and osteoporosis.Key words Diabetes mellitus Insulin-like growth factor Growth hormone Osteoporosis胰島素樣生長(zhǎng)因子(IGF)是一類既具有促細(xì)胞分化和增殖活性作用又具有胰島素樣活性作用的多肽，主要包括IGF-和IGF-兩種，對(duì)糖、脂肪代謝的作用與胰島素有類似之處。近年來(lái)研究發(fā)現(xiàn)：糖尿病患者血清IGF-水平降低，并與血糖的控制水平呈明顯負(fù)相關(guān)。糖尿病系全身性代謝異常疾病，存在骨代謝障礙，導(dǎo)致骨礦含量減少，引起骨質(zhì)疏松?，F(xiàn)已證實(shí)：IGF對(duì)成骨細(xì)胞和破骨細(xì)胞的作用和在骨質(zhì)疏松發(fā)生與發(fā)展

6、中的作用是不可忽視的1-4。本文測(cè)定了51例糖尿病病人血清IGF-、IGF-、GH及骨密度水平，以觀察胰島素樣生長(zhǎng)因子與骨質(zhì)疏松的關(guān)系，現(xiàn)將結(jié)果報(bào)告如下：1材料和方法1.1對(duì)象糖尿病組51例(男31例，女20例)平均年齡59.4歲。正常對(duì)照組40例(男女各20例)年齡與糖尿病組相匹配。1.2方法所有被檢人員均于清晨7時(shí)空腹采血，測(cè)定空腹血糖(FBG)、胰島素(INS)、C肽(C-P)、生長(zhǎng)激素(GH)以及IGF-、IGF-，進(jìn)早餐后2小時(shí)測(cè)餐后血糖(PBG)。FBG與PGB均用One touch血糖儀監(jiān)測(cè)；胰島素、C肽和GH放免測(cè)定試劑盒由天津DPC公司提供；IGF-采用法國(guó)Acouftor公

7、司生產(chǎn)的免疫試劑盒測(cè)定；IGF-采用美國(guó)MEDICAL CENTER BLRD公司生產(chǎn)的試劑盒測(cè)定；并且所有被檢測(cè)人員通過(guò)詢問(wèn)病史和體檢，排除骨代謝疾病、內(nèi)分泌系統(tǒng)等其他疾病如甲亢、婦科病、及半年內(nèi)未服用激素類等影響鈣磷代謝的藥物等情況，用單光子骨密度儀(SD-1000)測(cè)量前臂尺、橈骨骨礦含量。實(shí)驗(yàn)數(shù)據(jù)經(jīng)統(tǒng)計(jì)學(xué)處理，并作t檢驗(yàn)。2結(jié)果1.正常對(duì)照組及糖尿病組(不同體重指數(shù))的FBG、PBG、C-P、INS、GH、IGF-、IGF-測(cè)量結(jié)果見(jiàn)表1。表1糖尿病組與對(duì)照組的FBG、PBG、C肽、INS、IGF-、IGF-、BD、Ca、P(s)組別BMI例數(shù)FBG(mmol/l)PBG(mmol/l

8、)C肽(g/ml)INS(g/ml)IGF-(g/ml)IGF-(g/ml)BD(g/cm2)Ca(mmol/l)P(mmol/l)糖尿病組2428.334.013014.025.0719.435.753.841.1818.437.7610450.21484.19149.41663.893.572.370.11.260.192420.412.212110.443.0914.726.753.511.9115.399.9610858.28475.6164.58761.75114.982.850.161.130.28對(duì)照組21.363.18404.580.929.990.843.21.31131.3

9、1146.219.6245772.3780103.982.850.161.150.2P0.050.050.050.050.050.050.052.不同年齡組的糖尿病病人上述各項(xiàng)指標(biāo)見(jiàn)表2。 表2不同年齡糖尿病人FBG、PBG、C肽、GH、INS、IGF-、IGF-、BD、Ca、P(s)組別例數(shù)FBG(mmol/l)PBG(mmol/l)C肽(g/ml)INS(g/ml)GH(g/ml)IGF-(g/ml)IGF-(mg/ml)BD(g/cm2)Ca(mmol/l)P(mmol/l)30122.421.62.511.52.61.546747592.580.543040114.618.10.69.

10、81.71465547502.431.144150108.231.514.854.712.41.5414.937.143.754.19119.569.06464.38115.93755.5422.82.390.11.180.0751601611.763.5915.686.422.452.0414.698.443.673.05116.1556.44455.69146.4670.479.862.380.151.240.0261701812.085.3916.175.292.522.0417.798.543.221.3104.8248.02496.75174.21617.7158.062.30.11

11、.260.2671512.951.8320.264.872.851.5827.4311.5132.8191.57.72532.75248.01528.3318.562.230.051.30.2P0.050.050.050.050.050.050.053討論 文獻(xiàn)報(bào)道，隨著年齡的增長(zhǎng)，一些生理衰老的指標(biāo)如體內(nèi)脂肪增多、分布異常(脂肪在腹部和內(nèi)臟的增加比臀部、大腿和皮下多得多)、高腰圍/臀圍比、肌肉量及骨量縮減等，都可能與GH/IGF-軸的分化降低有關(guān)5-7，而這些又恰恰是糖尿病人群的特點(diǎn)。糖尿病病人因血糖控制不佳，長(zhǎng)期處于高血糖狀態(tài)，就可抑制IGF-的合成和釋放；并根據(jù)GH/IGF-軸的相互作用

12、(IGF-作為生長(zhǎng)介素能介導(dǎo)GH的生物作用，即GH對(duì)機(jī)體的促生長(zhǎng)作用由IGF-所介導(dǎo))，阻斷了GH對(duì)IGF-合成的促進(jìn)作用。因此，糖尿病病人血中IGF-水平是較正常人減低的。隨著年齡的增長(zhǎng)，血中IGF-水平逐漸下降。近年來(lái)的研究表明，健康的老年人血中IGF-水平較年輕人低30%40%，IGF-水平與年齡和脂肪含量呈負(fù)相關(guān)。由此看，年齡和脂肪是影響IGF-的因素8-9，本文所測(cè)結(jié)果與此報(bào)道一致。關(guān)于GH及IGF-對(duì)骨代謝的影響：GH可直接或通過(guò)IGF-間接改變骨代謝，IGF-可在骨組織中產(chǎn)生，在成骨細(xì)胞中有GH及IGF-受體10。IGF-在骨的形成中起一定作用，它以分泌的方式刺激成骨細(xì)胞的復(fù)制和

13、骨基質(zhì)的合成，所以IGF-是骨生成的有力刺激因子11。另有實(shí)驗(yàn)證實(shí)IGF-能刺激原有破骨細(xì)胞活性增強(qiáng)，促進(jìn)骨吸收1。另外，骨質(zhì)疏松病人用IGF-治療也顯示出有骨吸收增多2。從以上IGF對(duì)成骨細(xì)胞和破骨細(xì)胞的作用來(lái)看(骨再建立要包括成骨細(xì)胞形成和破骨細(xì)胞骨吸收)，IGF在骨質(zhì)疏松發(fā)生與發(fā)展中起著極其重要的作用。因此現(xiàn)在提出中老年人可用IGF-預(yù)防和減少骨質(zhì)疏松的發(fā)生13。短期間斷用IGF-治療骨質(zhì)疏松，療效評(píng)價(jià)現(xiàn)在還有待進(jìn)一步深入研究14。本文結(jié)果指出：胰島素樣生長(zhǎng)因子作為人類重要且作用廣泛的內(nèi)分泌因子，包括IGF-和IGF-兩種，兩者有相似的結(jié)構(gòu)和體外活性，但生物效應(yīng)不同。糖尿病病人血清僅顯示

14、IGF-水平降低，并且隨年齡、體重指數(shù)的增加而減少，它在骨質(zhì)疏松的發(fā)生與發(fā)展中起著重要作用。作者簡(jiǎn)介：史秀琴，1967年畢業(yè)于哈爾濱醫(yī)科大學(xué)現(xiàn)任哈爾濱醫(yī)科大學(xué)第四臨床醫(yī)學(xué)院教授，哈爾濱市第一醫(yī)院內(nèi)分泌科主任、主任醫(yī)師，中華醫(yī)學(xué)會(huì)黑龍江內(nèi)分泌專業(yè)委員會(huì)副主任委員，省糖尿病學(xué)會(huì)副主任委員，省風(fēng)濕病專業(yè)委員會(huì)副主任委員，黑龍江省骨質(zhì)疏松委員會(huì)會(huì)委。作者單位：150010哈爾濱市第一醫(yī)院內(nèi)分泌科參考文獻(xiàn)1Reed BY,Iranmanosh A,Veldhuis JD,et al.Clinical pathophysiology of the GH axis in adults,J Bone Mine

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