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摘要: 胰岛素样生长因子-1(insulin-like growth factor-1, IGF-1)介导生长激素(growth hormone, GH)在外周靶器官组织的促生长效应, 主要由肝脏合成, 循环中大部分IGF-1与特异的结合蛋白结合, 较GH更为稳定, 故临床测定IGF-1用于生长激素缺乏症、肢端肥大症的诊断及治疗监测等。目前IGF-1的测定方法主要有放射免疫法/免疫放射法、ELISA法、化学发光法、质谱分析法等, 不同方法各有利弊, 需要结合检测目的择优选择。IGF-1正常参考值范围的建立需基于背景人群随机抽样, 德国、意大利等欧洲国家及日本、韩国等亚洲国家已建立基于本国人群的血清IGF-1参考值范围。北京协和医院对北京及贵州地区汉族成人进行血清IGF-1水平测定, 初步建立了基于化学发光法的中国汉族成人血清IGF-1水平参考值范围, 为肢端肥大症、生长激素缺乏症等疾病的诊治奠定了基础。
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关键词:
- 胰岛素样生长因子-1 /
- 放射免疫法 /
- 化学发光法 /
- 参考值
Abstract: Insulin-like growth factor-1(IGF-1) mediates the growth-promoting effect of growth hormone on peripheral tissues, which is mainly synthesized in the liver. In the circulation, most IGF-1 binds to specific binding proteins, which is more stable than growth hormone. Therefore, IGF-1 is commonly used as a diagnostic marker and treatment monitor of growth hormone deficiency and acromegaly. There are many kinds of assays that measure serum IGF-1 concentrations, including radioimmunoassay, ELISA, chemiluminescence, and mass spectrometry. Different methods have their advantages and disadvantages, so it is necessary to select the best method according to the purpose of detection. The normal reference range of IGF-1 should be established based on a random sampling of the background population. Some European and Asian countries such as Germany, Italy, Japan, and South Korea have established reference ranges of serum IGF-1 based on their own population. ZHU Hui-juan et al. from Peking Union Medical College Hospital preliminarily established the reference range of serum IGF-1 of Han Chinese adults, laying a foundation for the diagnosis and treatment of acromegaly, growth hormone deficiency, and other diseases.利益冲突 无 -
表 1 IGF-1各类测定方法比较
方法 原理 优点 缺点 放射免疫法/免疫放射法 抗原抗体反应 试剂成本低，灵敏度高 操作复杂，存在放射性污染，有效期短 ELISA法 抗原抗体反应 试剂成本低，操作简单 灵敏度低，定性或半定量 化学发光法 抗原抗体反应 操作简单，成本低，灵敏度较高，试剂较稳定 工作曲线随时间漂移 质谱分析法 质荷比大小 灵敏度高，样品用量小 设备昂贵，操作复杂 IGF-1：胰岛素样生长因子-1 
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表 2 中国汉族健康成人血清IGF-1参考值范围(ng/ml)[39]
性别 年龄分组(岁) 标准差 百分位数 -2 SD -1 SD 中位数 +1 SD +2 SD P2.5 P97.5 男性 18 233.4 292.4 366.2 458.4 573.4 235.5 568.3 19 176.8 232.6 304.7 397.6 516.8 178.8 511.5 20~24 139.0 189.8 256.5 343.7 456.5 140.8 451.4 25~29 113.8 159.5 219.9 298.7 400.5 115.4 395.9 30~34 97.2 138.4 192.8 263.3 353.4 98.6 349.3 35~39 86.5 124.2 173.5 236.7 316.5 87.9 312.9 40~44 79.9 114.9 160.1 217.6 289.1 81.1 286.0 45~49 75.8 108.6 150.8 203.9 269.5 76.9 266.6 50~54 72.7 103.8 143.6 193.6 255.3 73.8 252.6 55~59 69.3 98.8 136.8 184.7 244.1 70.4 241.4 60~64 64.5 92.2 128.4 174.9 233.4 65.4 230.8 65~69 57.1 82.5 116.6 161.8 220.7 58.0 218.1 ≥70 46.8 68.7 99.5 142.7 202.3 47.6 199.5 女性 18 202.8 286.1 380.8 486.0 601.5 205.9 596.7 19 166.4 238.0 323.9 424.5 540.1 169.0 535.2 20~24 139.0 200.6 277.3 370.6 481.7 141.2 476.9 25~29 117.7 171.4 239.7 324.6 427.9 119.6 423.3 30~34 101.0 148.6 209.8 286.3 380.0 102.7 375.9 35~39 87.8 130.8 186.0 255.0 339.1 89.3 335.4 40~44 77.1 116.7 167.2 229.6 305.0 78.5 301.7 45~49 68.1 105.2 151.9 209.0 276.9 69.4 274.0 50~54 60.2 95.1 138.8 191.5 253.4 61.5 250.8 55~59 52.8 85.6 126.5 175.5 232.7 54.0 230.3 60~64 45.4 75.7 113.6 159.3 212.7 46.5 210.4 65~69 37.7 64.5 98.9 140.9 190.8 38.7 188.6 ≥70 29.6 51.5 80.9 118.2 164.0 30.3 162.0 总体 18 208.1 286.7 374.1 469.7 573.1 211.1 568.8 19 160.8 231.9 314.8 409.5 515.7 163.5 511.3 20~24 130.1 192.1 267.4 356.5 459.6 132.3 455.2 25~29 109.3 163.1 230.2 311.6 408.3 111.2 404.1 30~34 95.1 142.0 201.6 275.1 363.8 96.7 360.0 35~39 85.0 126.7 180.1 246.4 327.0 86.5 323.5 40~44 77.8 115.6 164.0 224.2 297.6 79.1 294.4 45~49 72.1 107.1 151.8 207.2 274.4 73.4 271.5 50~54 67.0 100.0 141.8 193.5 255.8 68.2 253.1 55~59 61.4 92.8 132.5 181.3 239.9 62.5 237.4 60~64 54.3 84.3 122.3 168.8 224.2 55.3 221.8 65~69 45.2 73.5 109.6 153.7 206.0 46.2 203.8 ≥70 34.0 59.6 92.7 133.3 181.5 34.8 179.4 IGF-1：同表 1；SD：标准差
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