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目的探讨胰岛素样生长因子Ⅰ(IGFⅠ)对正常儿童青春发育启动的可能作用。方法对北方大庆地区526名(男266,女260)健康的6～16岁小学和中学生进行4年的连续观察和研究。每年由相同的内分泌科医师进行体检,检查第二性征的发育,并按Tanner分期法行青春发育分期。同时采血用放射免疫测定或酶联免疫分析法测定血清LH、IGFⅠ和IGF结合蛋白3(IGFBP3)的水平。按年龄和青春发育分期分析血清LH和IGFⅠ、IGFBP3在青春发育过程中的变化及其关系。结果在儿童期不论是男孩还是女孩,随着年龄的增长,血清LH和IGFⅠ、IGFBP3水平有相似的升高趋势。男孩和女孩血清LH水平与IGFⅠ和IGFBP3水平都明显相关(均P<0.01)。血清IGFⅠ水平的开始明显升高在8岁,而LH水平的明显升高在10岁,表明血清IGFⅠ水平的升高要比LH升高早2年。以青春发育期进行分析,女孩在青春发育2期血清IGFⅠ水平明显高于1期,也早于LH水平升高(3期)。男孩则显示血清LH、IGFⅠ和IGFBP3水平在2期同时升高。结论儿童期循环中血清IGFⅠ水平的升高早于LH水平的升高,提示IGFⅠ可能是调节儿童青春发育启动的外周因素之一。
Objective To investigate the possible role of insulin-like growth factor Ⅰ (IGF-Ⅰ) in the initiation of puberty in normal children. Methods A total of 526 healthy (aged 266, 260) healthy primary and secondary school students aged 6-16 years in Daqing district of north China were observed and studied for 4 years continuously. Every year, the same endocrinologist conducts physical examinations to examine the development of secondary sexual characteristics and performs staging of puberty according to the Tanner staging method. At the same time, the levels of serum LH, IGF I and IGF binding protein 3 (IGFBP3) were determined by radioimmunoassay or enzyme-linked immunosorbent assay. The changes of serum LH, IGF Ⅰ and IGFBP3 during adolescence and their relationship were analyzed by age and adolescence. Results In childhood, both boys and girls, with age, serum LH and IGF Ⅰ, IGFBP3 levels have a similar upward trend. Serum LH levels in boys and girls were significantly correlated with both IGF1 and IGFBP3 levels (all P <0.01). Serum IGF Ⅰ levels began significantly elevated at 8 years old, while LH levels increased significantly at 10 years of age, indicating that serum IGF Ⅰ levels increased more than LH 2 years earlier. In the analysis of puberty, the level of serum IGF Ⅰ in girls during adolescence stage 2 was significantly higher than that in stage 1, and earlier than that in LH group (stage 3). Boys showed elevated levels of serum LH, IGF I, and IGFBP3 in phase 2 at the same time. Conclusion The increase of serum IGF Ⅰ level in childhood cycle is earlier than that in LH level, suggesting that IGF Ⅰ may be one of the peripheral factors that regulate the initiation of puberty in children.