Serum levels of IGF1 are a useful predictor of retinopathy of prematurity
Serum levels of IGF1 are a useful predictor of retinopathy of prematurity
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DOI：
10.1111/j.1651-2227.2009.01677.x
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发表时间：
2010-04-01
期刊：
影响因子：
3.8
通讯作者：
Fraga-Bermudez, J. M.
中科院分区：
文献类型：
--
作者：
Perez-Munuzuri, A.;Fernandez-Lorenzo, J. R.;Fraga-Bermudez, J. M.
目的：探讨胰岛素样生长因子1 （IGF1）是否与早产儿视网膜病变（ROP）相关，并作为预测早产儿视网膜病变的有效指标。虽然其病因是多因素的，但该疾病的发展似乎与IGF1缺乏有关，IGF1是一种激素，在视网膜正常血管生成中与血管内皮生长因子一起起作用。设计：前瞻性研究，为期30个月。参与者：74名小于1500克和/或小于32周胎龄的早产儿。测试：确定ROP的发展和严重程度。主要结局指标：每名受试者从出生至校正胎龄40周，每周一次测定血清IGF1水平。结果：32.4%的受试者出现了某种形式的ROP，所有ROP患者在出生时具有以下特征（中位+/-标准差评分）：体重低（1098 +/- 188比1393 +/- 285 g）、身长短（36.74 +/- 1.77比38.89 +/- 3.08 cm）、颅围小（26.03 +/- 1.74比27.93 +/- 1.81 cm）、胎龄小（29.7 +/- 1.78比31.3 +/- 1.79周）（p < 0.05）。先前与ROP相关的其他因素，在我们的ROP患者中也观察到有统计学意义的频率，包括支气管肺发育不良、颅内出血、需要红细胞输注或使用促红细胞生成素治疗和败血症（均p < 0.05）。与出生胎龄无关，发生ROP组产后第3周IGF1水平明显较低（29.13 vs 43.16 ng/mL, p < 0.05）。发现产后第三周IGF1值为30 ng/mL，诊断ROP的敏感性为90%。在第3周和第5周之间，IGF1水平的快速上升似乎与更高阶段ROP的发展有关。结论：产后第3周血清IGF1水平的测定，与出生胎龄无关，提供了一种充分可靠的预后工具，并允许识别一组高危患者。
Objective:To ascertain whether insulin-like growth factor 1 (IGF1) is associated with retinopathy of prematurity (ROP) and is a useful predictor of the disease. Although its aetiopathogenesis is multifactorial, development of the disease appears to be related to a deficiency in IGF1, a hormone that acts together with vascular endothelial growth factor in the normal angiogenesis in the retina.Design:Prospective study for a 30-month period.Participants:A total of 74 premature newborn babies, of less than 1500 g and/or 32 weeks' gestational age or less.Testing:To determine the development and severity of ROP.Main outcome measures:Serum levels of IGF1 were measured once a week from birth until 40 weeks corrected gestational age in each subject.Results:Of our subjects, 32.4% developed some form of ROP, and all those ROP patients had the following characteristics at birth (median +/- standard deviation scores): low weight (1098 +/- 188 vs. 1393 +/- 285 g), short length (36.74 +/- 1.77 vs. 38.89 +/- 3.08 cm), small cranial perimeter (26.03 +/- 1.74 vs. 27.93 +/- 1.81 cm) and young gestational age (29.7 +/- 1.78 vs. 31.3 +/- 1.79 weeks) (p < 0.05). Other factors previously associated with ROP that were also observed with statistically significant frequency in our ROP patients were bronchopulmonary dysplasia, intracranial haemorrhage, the need for erythrocyte transfusion or treatment with erythropoietin and sepsis (all p < 0.05). Levels of IGF1 at the 3rd week post-partum, independent of gestational age at birth, were clearly lower in the group who developed ROP (29.13 vs. 43.16 ng/mL, p < 0.05). A value of 30 ng/mL of IGF1 in the third week post-partum was found to have a 90% sensitivity in the diagnosis of ROP. A rapid rise in IGF1 levels between the 3rd and 5th weeks appeared to be related to the development of a higher stage of ROP.Conclusion:Determination of IGF1 serum levels in the 3rd week post-partum, independent of gestational age at birth, provides a sufficient and reliable prognostic tool and allows the identification of a group of patients at high risk of developing the disease.