Investigation Of Growth Hormone Insulin-like Growth Factor Axis In The Children With Congenital Heart Disease

Objective To investigate the change of growth hormone insulin-like growth factor(GH-IGF) axis in the children with congenital heart disease (CHD). Methods Fifty children with CHD[cyanotic group(n=13) and acyanotic group(n=37); the latter was divided to two sub-groups by heart function, heart failure group(n=25) and non-heart failure group(n=12)] and twenty normal children were enrolled in the study. Serum growth hormone binding protein (GHBP) was determined by enzyme-linked immunosorbent assay (ELISA); serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) were determined by immunoradiometric assay. Stature and weight were measured for evaluating their nutritional status through criteria of the Waterlow classification.Results The levels of serum IGF-1 and IGFBP-3 were decreased in the patients with CHD; they were significantly decreased in the cyanotic group and heart failure group. The level of serum GHBP was decreased in the cyanotic group and heart failure group. The acute malnutrition rate and chronic malnutrition rate in the children with CHD were 62% and 28% respectively. The acute malnutrition rate was similar between cyanotic group and acyanotic group (P>0.05); the chronic malnutrition rate was significantlyincreased in cyanotic group (P<0.01).Conclusions Decreased levels of serum IGF-1 and IGFBP-3 in the children with CHD are related to GHR. It is suggested that reduced growth hormone receptor status represents one of the molecular mechanisms of GH resistance in the children with CHD. Growth hormone resistance is one of the causes of malnutrition and growth failure in the children with CHD.