Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth
Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth
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DOI：
10.1542/peds.112.5.1016
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发表时间：
2003-11-01
期刊：
影响因子：
8
通讯作者：
Smith, LEH
中科院分区：
文献类型：
--
作者：
Hellström, A;Engström, E;Smith, LEH
目标。胰岛素样生长因子I （IGF-I）是小鼠和人类视网膜血管正常发育所必需的。由于早产儿视网膜病变（ROP）是由出生后视网膜发育异常引起的，我们假设早产儿长期低igf - 1可能是发生ROP的危险因素。我们进行了一项前瞻性、纵向研究，对84名早产儿从出生（经后年龄：24-32周）到出院，每周测量血清IGF-I浓度。评估婴儿ROP和其他早产儿发病率：支气管肺发育不良（BPD）、脑室内出血（IVH）和坏死性小肠结肠炎（NEC）。低血清IGF-I值与ROP的后期发展相关。30-33周的经后IGF-I+/-SEM平均水平在严重ROP时最低（25+/-2.41马克/升），中度ROP时最低（29+/-1.76马克/升），无ROP时最低（33+/-1.72马克/升）。低IGF-I的持续时间也与ROP的严重程度密切相关。从出生到血清IGF-I水平达到bbbb33马克杯/升，无ROP为23+/-2.6天，中度ROP为44+/-4.8天，严重ROP为52+/-7.5天。在经后30 ~ 33周，IGF-I每增加5杯/升，可使增殖性ROP的风险降低45%。其他并发症（NEC、BPD、IVH）与ROP和低IGF-I水平相关。如果在月经后33周时igf - 1小于或等于33马克杯/升，任何发病（ROP、BPD、IVH或NEC）的相对风险增加2.2倍（95%可信区间：1.41-3.43）。这些结果表明，早产后持续低血清igf - 1浓度与ROP的后期发展和其他早产并发症有关。igf - 1至少与经后出生年龄和出生体重一样是ROP风险的决定因素。
Objective. Insulin-like growth factor I (IGF-I) is necessary for normal development of retinal blood vessels in mice and humans. Because retinopathy of prematurity (ROP) is initiated by abnormal postnatal retinal development, we hypothesized that prolonged low IGF-I in premature infants might be a risk factor for ROP.Design. We conducted a prospective, longitudinal study measuring serum IGF-I concentrations weekly in 84 premature infants from birth (postmenstrual ages: 24-32 weeks) until discharge from the hospital. Infants were evaluated for ROP and other morbidity of prematurity: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC).Results. Low serum IGF-I values correlated with later development of ROP. The mean IGF-I+/-SEM level during postmenstrual ages 30-33 weeks was lowest with severe ROP (25+/-2.41 mug/L), 29+/-1.76 mug/L with moderate ROP, and 33+/-1.72 mug/L with no ROP. The duration of low IGF-I also correlated strongly with the severity of ROP. The interval from birth until serum IGF-I levels reached >33 mug/L was 23+/-2.6 days for no ROP, 44+/-4.8 days for moderate ROP, and 52+/-7.5 days for severe ROP. Each adjusted stepwise increase of 5 mug/L in mean IGF-I during postmenstrual ages 30 to 33 weeks decreased the risk of proliferative ROP by 45%. Other complications (NEC, BPD, IVH) were correlated with ROP and with low IGF-I levels. The relative risk for any morbidity (ROP, BPD, IVH, or NEC) was increased 2.2-fold (95% confidence interval: 1.41-3.43) if IGF-I was less than or equal to33 mug/L at 33 weeks' postmenstrual age.Conclusions. These results indicate that persistent low serum concentrations of IGF-I after premature birth are associated with later development of ROP and other complications of prematurity. IGF-I is at least as strong a determinant of risk for ROP as postmenstrual age at birth and birth weight.