本文選題：胰島素生長(zhǎng)因子 + 胰島素生長(zhǎng)因子結(jié)合蛋白��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:胰島素樣生長(zhǎng)因子-1(insulin-like growth factor-1,IGF-1)屬于胰島素類(lèi)激素家族中的成員之一,是一種在分子結(jié)構(gòu)上與胰島素類(lèi)似的多肽蛋白物質(zhì)。對(duì)人和動(dòng)物的生長(zhǎng)、發(fā)育和代謝具有重要的調(diào)節(jié)作用。通過(guò)與胰島素樣生長(zhǎng)因子受體(insulin-like growth factor-1 receptor,IGF-1R)和胰島素樣生長(zhǎng)因子結(jié)合蛋白(insulin-like growth factor bindingproteins,IGFBPs)結(jié)合,發(fā)揮著廣泛的生理作用,可促進(jìn)細(xì)胞增殖、調(diào)節(jié)骨骼的生長(zhǎng)、調(diào)節(jié)機(jī)體生長(zhǎng)發(fā)育和物質(zhì)代謝。生長(zhǎng)激素(growth hormone,GH)的促生長(zhǎng)作用是由IGF-1介導(dǎo)的。室間隔缺損(ventricular septal defect,VSD)為最常見(jiàn)的先天性心臟畸形,這類(lèi)患者在出生時(shí)就存在的心血管結(jié)構(gòu)或功能異常。本文旨在通過(guò)檢測(cè)VSD患兒介入治療前后IGF-1和胰島素樣生長(zhǎng)因子結(jié)合蛋白-3(insulin-like growth factor bindingprotein-3,IGFBP-3)水平的變化,結(jié)合超聲心動(dòng)圖,探討二因子在介入治療手術(shù)前后的變化及是否可以有效地反映VSD患兒介入治療前后心臟結(jié)構(gòu)的改變及心功能狀態(tài)。方法:選擇從2015年09月-2016年03月在河北醫(yī)科大學(xué)第一醫(yī)院通過(guò)超聲心動(dòng)圖進(jìn)行篩選出可介入治療的VSD患兒且介入封堵治療成功的30例作為VSD組,年齡范圍2-8歲,平均年齡:4.40±1.92歲,采用放射免疫測(cè)定法測(cè)定介入治療前、介入治療后1周、1個(gè)月、3個(gè)月、6個(gè)月和1年空腹血IGF-1及IGFBP-3水平;對(duì)照組為30例本地健康同齡兒童,年齡范圍:2-8歲,平均年齡為4.30±2.00歲。同時(shí)對(duì)VSD患兒組在介入治療前、術(shù)后1周、術(shù)后1個(gè)月、術(shù)后3個(gè)月和術(shù)后6個(gè)月分別行超聲心動(dòng)圖檢查進(jìn)行心臟結(jié)構(gòu)和功能的評(píng)價(jià)。指標(biāo)包括:右室橫徑(RV)、左房前后徑(LA)、右房橫徑(RA)、左室舒張末前后徑(LVEDD)、左室收縮末前后徑(LVESD)、左室收縮末容量(LVESV)、左室舒張末容量(LVEDV)、每搏輸出量(SV)、射血分?jǐn)?shù)(EF)。介入治療前及術(shù)后1周、術(shù)后1個(gè)月、術(shù)后3個(gè)月和術(shù)后6個(gè)月觀察患兒心率、血壓、心臟雜音、是否并發(fā)心律失常、心臟瓣膜返流、心功能不全等情況。統(tǒng)計(jì)學(xué)處理:計(jì)量資料正態(tài)分布的資料應(yīng)用均數(shù)±標(biāo)準(zhǔn)差表示,成組設(shè)計(jì)資料的均數(shù)比較方差齊用t檢驗(yàn),方差不齊用t′檢驗(yàn),計(jì)數(shù)資料采用卡方檢測(cè),同組不同時(shí)間點(diǎn)的比較采用重復(fù)測(cè)量方差分析,變量間相關(guān)性采用直線相關(guān)分析,偏態(tài)資料采用秩和檢驗(yàn),相關(guān)分析采用pearson相關(guān)分析,檢驗(yàn)水準(zhǔn)為0.05(雙側(cè)),p0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1研究對(duì)象一般資料的比較:vsd患兒組和健康兒童組在年齡、身高、體重、性別無(wú)顯著性差異;2igf-1及igfbp-3水平的變化:血清igf-1的變化:術(shù)前vsd組和健康兒童組比較,明顯低于健康兒童組,有顯著性差異(p0.01);術(shù)后血清igf-1各時(shí)間點(diǎn)的濃度水平進(jìn)行統(tǒng)計(jì)分析,vsd患兒從介入術(shù)后開(kāi)始血清igf-1水平緩慢升高,術(shù)后1周最為明顯,各時(shí)間節(jié)點(diǎn)均有統(tǒng)計(jì)學(xué)差異,隨訪至術(shù)后1年,其血清濃度基本和健康兒童持平,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);血清igfbp-3的變化:術(shù)前vsd組和健康兒童組比較,明顯低于健康兒童組,有顯著性差異(p0.01);術(shù)后血清igfbp-3各時(shí)間點(diǎn)的濃度水平進(jìn)行統(tǒng)計(jì)分析,vsd患兒從介入術(shù)后開(kāi)始血清igfbp-3水平緩慢升高,術(shù)后1周最為明顯,各時(shí)間節(jié)點(diǎn)均有統(tǒng)計(jì)學(xué)差異,隨訪至術(shù)后1年,其血清濃度基本和健康兒童持平,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);3vsd介入治療前后房室結(jié)構(gòu)及心功能改變:vsd組在介入治療術(shù)后1周、術(shù)后1個(gè)月、術(shù)后3個(gè)月、術(shù)后6個(gè)月分別行超聲心動(dòng)圖檢查,lvedd,lvesd,lvesv,lvedv,sv均較術(shù)前逐步減小,各時(shí)間節(jié)點(diǎn)均有統(tǒng)計(jì)學(xué)差異。而rv,ra,la,ef較術(shù)前無(wú)顯著性差異;4vsd組患兒介入術(shù)后近期情況:所有vsd患兒在介入治療后生命體征均無(wú)明顯改變,心臟雜音明顯減輕或消失,3例患兒在介入治療過(guò)程中一過(guò)性出現(xiàn)心律失常,經(jīng)處理后均恢復(fù)正常,無(wú)并發(fā)心臟瓣膜損傷及心功能異常,無(wú)一例死亡。5igf-1、igfbp-3與心臟結(jié)構(gòu)及功能相關(guān)性:治療前后igf-1與rv、lvedd、lvedv、lvesv、sv均具有相關(guān)性,其相關(guān)系數(shù)分別為-0.618、-0.548、-0.446、-0.412、-0.438,差異有統(tǒng)計(jì)學(xué)意義(p0.05);igfbp-3與rv、lvedd、lvedv、lvesv、sv均具有相關(guān)性,其相關(guān)系數(shù)分別為-0.643、-0.508、-0.521、-0.516、-0.488,差異有統(tǒng)計(jì)學(xué)意義(p0.05),與RA、EF、LA、LVESD無(wú)明顯相關(guān)性(P0.05)。結(jié)論:1 VSD患兒存在著IGF-1及IGFBP水平的變化且介入封堵治療能夠糾正VSD患兒存在的二因子的變化。2 VSD患兒介入術(shù)前后IGF-1及IGFBP-3水平的變化,間接反映VSD患兒心臟容量負(fù)荷、心腔大小的變化,并可評(píng)估介入術(shù)后心功能變化。
[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.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R725.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 韓宇;高傳玉;徐紅黨;范太兵;彭幫田;李斌;劉琳;潘湘斌;程兆云;;單純食管超聲引導(dǎo)經(jīng)股動(dòng)脈逆行封堵室間隔缺損的可行性[J];中華醫(yī)學(xué)雜志;2016年14期

2 郭丙鋼;;心臟彩超用于先天性心臟病介入治療的臨床價(jià)值[J];臨床醫(yī)藥文獻(xiàn)電子雜志;2016年03期

3 干冬梅;石小軍;;重組人生長(zhǎng)激素對(duì)特發(fā)性矮小患兒癥血清胰島素樣生長(zhǎng)因子1與胰島素樣生長(zhǎng)因子結(jié)合蛋白3水平的影響[J];中國(guó)生化藥物雜志;2015年12期

4 謝育梅;邱慶歡;張智偉;張愛(ài)華;李俊杰;李渝芬;潘微;陳雄英;申俊君;;生物陶瓷鍍膜封堵器治療兒童左向右分流型先天性心臟病的中遠(yuǎn)期隨訪研究[J];中華實(shí)用兒科臨床雜志;2015年11期

5 徐焰;徐修禮;馬越云;沈?qū)W鋒;劉明朝;任麗芬;張志平;秦慶;郝曉柯;;GHD矮小兒童血清IGF-1水平與血鉛的相關(guān)性研究及其機(jī)制探討[J];中華檢驗(yàn)醫(yī)學(xué)雜志;2015年04期

6 郭俊曉;張玉龍;朱憲明;劉志平;趙龍;李淑珍;王堅(jiān);;國(guó)產(chǎn)Amplazter封堵器介入治療先天性心臟病200例療效觀察[J];中國(guó)心血管病研究;2015年03期

7 柯蕊;吳媛媛;王貴佐;李滿(mǎn)祥;;胰島素抵抗與肺動(dòng)脈高壓關(guān)系的研究進(jìn)展[J];南方醫(yī)科大學(xué)學(xué)報(bào);2015年02期

8 張若溪;孫勇;袁杰;陳樹(shù)源;于波;;隨機(jī)、平行對(duì)照評(píng)價(jià)陶瓷膜室間隔缺損封堵器安全性和有效性[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2014年34期

9 潘娟;劉亞平;孫建輝;;國(guó)產(chǎn)封堵器介入治療先天性心臟病39例臨床分析[J];中國(guó)心血管病研究;2014年12期

10 梁妍琰;于少飛;;兒童矮小癥常見(jiàn)發(fā)病原因及治療方案[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2014年20期

，

本文編號(hào)：1878069