阻塞性黄疸患者生长激素/胰岛素样生长因子-Ⅰ轴变化的研究

目的　探讨阻塞性黄疸患者生长激素/胰岛素样生长因子-Ⅰ轴的变化及其临床意义。方法　对60例男性阻塞性黄疸患者（阻黄组）围手术期血浆生长激素、生长激素结合蛋白、胰岛素样生长因子，内毒素、肝功能及前白蛋白水平进行观察，并与40例男性单纯性胆囊结石患者（对照组）进行比较。结果　生长激素、生长激素结合蛋白、胰岛素样生长因子-Ⅰ在阻黄组分别为7.4μg/L±3.6μg/L、9.1±2.3B/T*100、49.8mg/L±6.6mg/L，较对照组（13.9μg/L±5.7μg/L、13.3±1.6B/T*100、61.4mg/L±6.5mg/L显著降低，差异有显著意义(P<0.01)，并与黄疸程度，前白蛋白、内毒素水平相关(P<0.01)。结论　阻塞性黄疸患者生长激素/胰岛素样生长因子-Ⅰ轴存在明显下调。其原因可能与营养障碍、内毒素血症引起的生长激素受体表达受抑有关，并可进一步加重营养障碍和内毒素血症，是介导阻塞性黄疸病理生理改变的重要因素。

Clinical study on the changes of growth hormone/insulin-like growth factor-Ⅰaxis in patient with obstructive jaundice

OBJECTIVE: To explore the changes and clinical significance of growth hormone (GH)/insulin-like growth factor-I (IGF-I) axis in patient with obstructive jaundice (OJ). METHODS: The serum GH, GH binding protein (GHBP), IGF-I, endotoxin, prealbumin, and liver function of 60 male in- patients with OJ were investigated 1 day before operation and 1, 3, and 7 days after the operation. Forty male patients with simple gallbladder stone who were hospitalized during the same period as the 60 above mentioned patients, were chosen as controls. RESULTS: The levels of GH, GHBP and IGF-I in patients with obstructive jaundice were significantly lower (7.4 micrograms/L +/- 3.6 micrograms/L, 9.1 +/- 2.3 B/T* 100, and 49.8 mg/L +/- 6.6 mg/L respectively) than those in control group(13.9 micrograms/L +/- 5.7 micrograms/L, 13.3 +/- 1.6 B/T* 100, and 61.4 mg/L +/- 6.5 mg/L respectively, P < 0.01) and were correlated closely with the levels of bilirubin, prealbumin and endotoxin (P < 0.01). CONCLUSION: There is an obvious downregulation of GH-IGF-I axis in patients with OJ probably because of the expression inhibition resulting from dystrophy and endoxemia. It may be one of the important factors mediating the pathophysiological changes in OJ.