【作者】 李薇；

【导师】 余涛；

【作者基本信息】 四川大学 ， 儿科学（专业学位）， 2023， 硕士

【摘要】 目的:25-羟基维生素D(25(OH)D)和生长激素-胰岛素样生长因子(GH-IGF)轴对儿童骨骼健康和纵向生长至关重要,二者可能存在一定的相互作用,然而目前国内外有关二者关系的研究结论既不一致也不明确。在此,我们通过一项横断面研究来深入探讨25(OH)D和GH-IGF轴的关系。材料和方法:这项研究纳入了四川大学华西第二医院就诊的1117例青春期前矮小儿童。自变量为25(OH)D,因变量分别为胰岛素样生长因子1(IGF-1)、胰岛素样生长因子结合蛋白3(IGFBP-3)、IGF-1/IGFBP-3、生长激素激发试验峰值。协变量包含性别、年龄、季节、体质指数(BMI)、血清总蛋白、碱性磷酸酶(ALP)、游离甲状腺素(FT4)、总钙。采用不同的回归模型分析25(OH)D与GH-IGF轴的独立关系,同时还将搜集的数据进行了趋势性检验、平滑曲线拟合、分层分析和交互作用检验。结果:经调整混杂因素的影响后,25(OH)D与IGF-1、IGF-1/IGFBP-3均无相关性(分别为β=-0.225,95%CI:-0.496,0.045,P=0.102;β=-0.063,95%CI:-0.180,0.053,P=0.286),25(OH)D与IGFBP-3水平呈正相关(β=0.007,95%CI:0.001,0.013,P=0.023)。亚组分析显示25(OH)D和IGFBP-3在每个亚组的效应值方向相同,即每个亚组中25(OH)D和IGFBP-3均呈正相关。平滑曲线拟合显示25(OH)D与生长激素峰值呈曲线关系。结论:这项研究证明了25(OH)D与GH-IGF轴间存在一定关联,为25(OH)D和GH-IGF轴之间的相互作用提供了更多见解。但未来仍需要多中心、较大规模的随机对照研究来深入探讨维生素D和GH-IGF轴在以身材矮小为特征的疾病中的生物学相互作用,从而为矮小儿童的骨骼健康及线性生长提供临床指导。更多还原

【Abstract】 Objective:25-hydroxyvitamin D(25(OH)D)and growth hormone-insulin-like growth factor(GH-IGF)axis are essential for bone health and longitudinal growth in children,and there may be interaction between them.However,the current research conclusions on the association between the two are neither consistent nor clear.Herein,we conducted a cross-sectional study to explore the relationship between25(OH)D and GH-IGF axis.Materials and Methods:This study included 1117 prepubertal short children treated at the West China Second University Hospital,Sichuan University.The independent variable was25(OH)D,and the dependent variables were insulin-like growth factor 1(IGF-1),IGF-binding protein 3(IGFBP-3),IGF-1/IGFBP-3,and peak value of growth hormone stimulation test,respectively.The covariates included sex,age,season,body mass index(BMI),serum total protein,alkaline phosphatase(ALP),free thyroxine(FT4),and total calcium.The relationship between 25(OH)D and GH-IGF axis was analyzed by different regression models.Trend tests,smooth curve fitting,interaction,and hierarchical analyses were also performed.Results:There was no correlation between 25(OH)D and IGF-1 or IGF-1/IGFBP-3 after adjusting for confounding factors(β=-0.225,95% CI:-0.496,0.045,P=0.102;β=-0.063,95% CI:-0.180,0.053,P=0.286,respectively).While 25(OH)D was positively correlated with IGFBP-3(β=0.007,95% CI: 0.001,0.013,P=0.023).Subgroup analysis showed that 25(OH)D and IGFBP-3 had the same effect value direction in each subgroup;that is,25(OH)D and IGFBP-3 were positively correlated in each subgroup.Smooth curve fitting showed a curvilinear relationship between 25(OH)D and growth hormone peak.Conclusion:This study proved a specific correlation between 25(OH)D and GH-IGF axis and provided more insights into the interaction between the two.However,multicenter and large-scale randomized controlled trials are still needed to further understand the biological interaction between vitamin D and GH-IGF axis in short stature to provide clinical guidance for short children’s bone health and linear growth.更多还原