室间隔缺损患儿介入治疗前后血清IGF-1和IGFBP-3水平的变化及其与心功能的关系

发布时间：2018-05-12 09:30

本文选题：胰岛素生长因子 + 胰岛素生长因子结合蛋白　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)属于胰岛素类激素家族中的成员之一,是一种在分子结构上与胰岛素类似的多肽蛋白物质。对人和动物的生长、发育和代谢具有重要的调节作用。通过与胰岛素样生长因子受体(insulin-like growth factor-1 receptor,IGF-1R)和胰岛素样生长因子结合蛋白(insulin-like growth factor bindingproteins,IGFBPs)结合,发挥着广泛的生理作用,可促进细胞增殖、调节骨骼的生长、调节机体生长发育和物质代谢。生长激素(growth hormone,GH)的促生长作用是由IGF-1介导的。室间隔缺损(ventricular septal defect,VSD)为最常见的先天性心脏畸形,这类患者在出生时就存在的心血管结构或功能异常。本文旨在通过检测VSD患儿介入治疗前后IGF-1和胰岛素样生长因子结合蛋白-3(insulin-like growth factor bindingprotein-3,IGFBP-3)水平的变化,结合超声心动图,探讨二因子在介入治疗手术前后的变化及是否可以有效地反映VSD患儿介入治疗前后心脏结构的改变及心功能状态。方法:选择从2015年09月-2016年03月在河北医科大学第一医院通过超声心动图进行筛选出可介入治疗的VSD患儿且介入封堵治疗成功的30例作为VSD组,年龄范围2-8岁,平均年龄:4.40±1.92岁,采用放射免疫测定法测定介入治疗前、介入治疗后1周、1个月、3个月、6个月和1年空腹血IGF-1及IGFBP-3水平;对照组为30例本地健康同龄儿童,年龄范围:2-8岁,平均年龄为4.30±2.00岁。同时对VSD患儿组在介入治疗前、术后1周、术后1个月、术后3个月和术后6个月分别行超声心动图检查进行心脏结构和功能的评价。指标包括:右室横径(RV)、左房前后径(LA)、右房横径(RA)、左室舒张末前后径(LVEDD)、左室收缩末前后径(LVESD)、左室收缩末容量(LVESV)、左室舒张末容量(LVEDV)、每搏输出量(SV)、射血分数(EF)。介入治疗前及术后1周、术后1个月、术后3个月和术后6个月观察患儿心率、血压、心脏杂音、是否并发心律失常、心脏瓣膜返流、心功能不全等情况。统计学处理:计量资料正态分布的资料应用均数±标准差表示,成组设计资料的均数比较方差齐用t检验,方差不齐用t′检验,计数资料采用卡方检测,同组不同时间点的比较采用重复测量方差分析,变量间相关性采用直线相关分析,偏态资料采用秩和检验,相关分析采用pearson相关分析,检验水准为0.05(双侧),p0.05为差异有统计学意义。结果:1研究对象一般资料的比较:vsd患儿组和健康儿童组在年龄、身高、体重、性别无显著性差异;2igf-1及igfbp-3水平的变化:血清igf-1的变化:术前vsd组和健康儿童组比较,明显低于健康儿童组,有显著性差异(p0.01);术后血清igf-1各时间点的浓度水平进行统计分析,vsd患儿从介入术后开始血清igf-1水平缓慢升高,术后1周最为明显,各时间节点均有统计学差异,随访至术后1年,其血清浓度基本和健康儿童持平,差异无统计学意义(p0.05);血清igfbp-3的变化:术前vsd组和健康儿童组比较,明显低于健康儿童组,有显著性差异(p0.01);术后血清igfbp-3各时间点的浓度水平进行统计分析,vsd患儿从介入术后开始血清igfbp-3水平缓慢升高,术后1周最为明显,各时间节点均有统计学差异,随访至术后1年,其血清浓度基本和健康儿童持平,差异无统计学意义(p0.05);3vsd介入治疗前后房室结构及心功能改变:vsd组在介入治疗术后1周、术后1个月、术后3个月、术后6个月分别行超声心动图检查,lvedd,lvesd,lvesv,lvedv,sv均较术前逐步减小,各时间节点均有统计学差异。而rv,ra,la,ef较术前无显著性差异;4vsd组患儿介入术后近期情况:所有vsd患儿在介入治疗后生命体征均无明显改变,心脏杂音明显减轻或消失,3例患儿在介入治疗过程中一过性出现心律失常,经处理后均恢复正常,无并发心脏瓣膜损伤及心功能异常,无一例死亡。5igf-1、igfbp-3与心脏结构及功能相关性:治疗前后igf-1与rv、lvedd、lvedv、lvesv、sv均具有相关性,其相关系数分别为-0.618、-0.548、-0.446、-0.412、-0.438,差异有统计学意义(p0.05);igfbp-3与rv、lvedd、lvedv、lvesv、sv均具有相关性,其相关系数分别为-0.643、-0.508、-0.521、-0.516、-0.488,差异有统计学意义(p0.05),与RA、EF、LA、LVESD无明显相关性(P0.05)。结论:1 VSD患儿存在着IGF-1及IGFBP水平的变化且介入封堵治疗能够纠正VSD患儿存在的二因子的变化。2 VSD患儿介入术前后IGF-1及IGFBP-3水平的变化,间接反映VSD患儿心脏容量负荷、心腔大小的变化,并可评估介入术后心功能变化。
[Abstract]:Objective: insulin like growth factor -1 (insulin-like growth factor-1, IGF-1) is one of the members of the insulin class hormone family. It is a polypeptide protein substance similar to insulin on the molecular structure. It plays an important role in regulating the growth, development and metabolism of human and animal. It is used with the insulin like growth factor receptor (Insuli). N-like growth factor-1 receptor, IGF-1R) and insulin like growth factor binding protein (insulin-like growth factor bindingproteins, IGFBPs) are combined to play a broad physiological role in promoting cell proliferation, regulating bone growth, regulating body growth and metabolism. Growth hormone (growth hormone) growth promoting growth IGF-1 mediated ventricular septal defect (VSD) is the most common congenital heart malformation. These patients have cardiovascular structural or functional abnormalities at birth. The purpose of this study was to detect IGF-1 and insulin like growth factor binding protein -3 (insulin-like growth factor) before and after interventional therapy in children with VSD Bindingprotein-3, IGFBP-3) level changes, combined with echocardiography, to explore the changes of two factors before and after interventional therapy and whether it can effectively reflect the changes of cardiac structure and cardiac function in children with VSD before and after interventional therapy. Methods: select from 09 month of 2015, -2016 year, 03 month in the first Hospital of Hebei Medical University through ultrasound 30 cases of VSD children with interventional therapy and successful interventional therapy were selected as VSD group. The age range was 2-8 years old, the average age was 4.40 + 1.92 years old. The radioimmunoassay was used to determine the IGF-1 and IGFBP-3 levels in the fasting blood for 1 weeks, 1 months, 3 months, 6 months and 1 years after interventional therapy, and 30 cases in the control group. The age range of the children of the same age was 2-8 years old, with an average age of 4.30 + 2 years. At the same time, the cardiac structure and function were evaluated by echocardiography at 1 weeks after the operation, 1 months after the operation, 3 months after the operation and 6 months after the operation, including the right ventricular diameter (RV), the left anterior anterior and posterior diameter (LA), right atrium transverse diameter (RA), and the left side of the VSD group. Ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), stroke volume (SV) and ejection fraction (EF). Before and 1 weeks after intervention, 1 months after operation, 3 months after operation and 6 months after operation, the heart rate, blood pressure, heart murmur, heart arrhythmia, heart arrhythmia, heart disease, heart arrhythmia, heart disease, heart arrhythmia, heart Valvular regurgitation and cardiac dysfunction. Statistical processing: the data of normal distribution of the measured data were expressed by mean number of standard deviations, the average variance of the group design data was t test, the variance was t 'test, the count data were checked by chi square, and the comparison of the same group was compared with the variable analysis of variance, and the variable between the variables. The correlation was linear correlation analysis, partial data used rank sum test, correlation analysis adopted Pearson correlation analysis, the test level was 0.05 (bilateral), and P0.05 was statistically significant. Results: 1 the comparison of the general data of the study subjects: there was no significant difference in age, height, weight and sex between children of VSD and healthy children; 2igf-1 and IGFBP Changes in the level of -3: the changes in serum IGF-1: before operation, the VSD group and the healthy children group were significantly lower than the healthy children group. There was a significant difference (P0.01). The concentration level of IGF-1 at each time point of serum IGF-1 after operation was statistically analyzed. The serum IGF-1 water of VSD children began to slow slowly and slowly after the intervention, and the most obvious after 1 weeks after the operation. Statistical difference, followed up to 1 years after the operation, the serum concentration was basically equal to that of healthy children, the difference was not statistically significant (P0.05), and the changes of serum IGFBP-3: compared with the healthy children group before operation, the VSD group and the healthy children group were significantly lower than those in the healthy children group (P0.01); the concentration level of the serum IGFBP-3 at each time point after the operation was statistically analyzed, the VSD children were statistically analyzed. The serum IGFBP-3 level began to rise slowly after the intervention, and the most obvious 1 weeks after the operation. All the time nodes had statistical difference, and followed up to 1 years after the operation, the serum concentration was basically equal to that of the healthy children. The difference was not statistically significant (P0.05); the changes of the atrioventricular node and cardiac function before and after the 3vsd intervention were 1 weeks after the interventional therapy, after the operation, and after the operation. 1 months, 3 months after operation, 6 months after 6 months of echocardiography, LVEDd, LVESD, LVESV, LVEDV, SV were gradually decreased compared with the preoperative nodes, and there were statistical differences in each time. But RV, RA, La, EF were no significant difference compared with before the operation; in the 4vsd group, there were no significant changes in the vital signs of all VSD children after interventional therapy. Cardiac murmur was obviously reduced or disappeared. 3 cases had arrhythmia in the process of interventional therapy. After treatment, all patients recovered normal, no heart valve injury and abnormal cardiac function, no death.5igf-1, IGFBP-3 and cardiac structure and function correlation: IGF-1 and RV, LVEDd, LVEDV, LVESV, SV were all related before treatment. The correlation coefficients were -0.618, -0.548, -0.446, -0.412, -0.438, and the differences were statistically significant (P0.05); IGFBP-3 and RV, LVEDd, LVEDV, LVESV were all correlated. Changes in IGF-1 and IGFBP levels and interventional therapy can correct the changes of two factors in children with VSD, the changes of IGF-1 and IGFBP-3 levels in children with.2 VSD before and after intervention, indirectly reflecting the cardiac volume load and the change of the heart size in children with VSD, and assessing the changes of cardiac function after intervention.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4

【参考文献】