Valores de IGF-I séricos en la ROP. Buscando nuevas indicaciones para su screening

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Abstract

Objetivo: Determinar los niveles séricos IGF-I en niños prematuros con el objetivo de que éstos, pueden ser usados como indicadores de la exploración en el despistaje de la ROP. Método: Nuestro estudio se diseña como transversal comparativo, midiendo los valores de IGF-I en suero de cada niño en la primera exploración entre las primeras 4-6 semanas postnatales. Se evaluaron el grado de ROP y otros factores de morbilidad: hemorragia intraventricular, sepsis, transfusiones y días de ventilación mecánica. Resultados: Los valores medios de la IGF-I entre las 4-6 primeras semanas postnatales fue más baja en los casos de ROP, 10,75 µg/L D.E. 16,053, siendo los casos de No ROP de 29,75 µg/L D.E. 13,022. El test de la U de Mann-Whitney reflejó un valor de la P para los valores de IGF-I de .004, indicando así diferencias significativas entre los dos grupos. Conclusión: Los bajos niveles de IGF-I séricos en niños con ROP en comparación con los casos de no ROP, sugieren que este marcador podría servir como indicador del screening de la ROP.

Translated abstract

Objective: To determine the IGF-I serum levels in premature infants with the objective of being able to use these levels as an indicator of the need for exploration in a screening program for retinopathy of prematurity (ROP). Methods: This was a comparative study in which IGF-I levels were measured in every infants’ serum during the first exploration in the 4 to 6 postnatal weeks. The degree of ROP and a variety of morbidity factors were evaluated, including the presence of intraventricular haemorrhage, sepsis, need for blood transfusion and the number of days of mechanical ventilation. Results: The average IGF-I values during the first 4 to 6 postnatal weeks were lowest in the ROP cases (10.75 µg/L SD 16.053) while the NO-ROP cases yielded higher values (29.75 µg/L, SD 13.022). The Mann-Whitney U test showed a value of P for the IGF-I values of 0.004, indicating significant differences between the groups with or without ROP. Conclusions: The low IGF-I serum levels in ROP infants in comparison with the NO-ROP cases, suggest that this marker could be used as an indicator in the screening for ROP.

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Most cited references 19

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Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth.

Anna-Lena Hård, Chatarina Löfqvist, Uwe Ewald … (2003)

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. 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). 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 micro g/L), 29 +/- 1.76 micro g/L with moderate ROP, and 33 +/- 1.72 micro g/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 micro g/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 micro g/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

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Incidence and early course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group.

Matthew C L Phillips, V. Schaffer, Le B. Tung … (1991)

In the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (ROP), 4099 infants weighing less than 1251 g at birth underwent sequential ophthalmic examinations, beginning at age 4 to 6 weeks, to monitor the incidence and course of ROP. Overall, 65.8% of the infants developed ROP to some degree; 81.6% for infants of less than 1000 g birth weight. As expected, ROP incidence and severity were higher in lower birth weight and gestational age categories. Black infants appeared less susceptible to ROP, of all severity categories, than nonblack infants. The timing of retinal vascular events correlated more closely with postconceptional age than with postnatal age, implicating the level of maturity more than postnatal environmental influences in governing the timing of these vascular events. These results include the current incidence of various severity stages of ROP found in the United States and provide new insight into the development of ROP.

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IGF-I is critical for normal vascularization of the human retina.

Zvi Laron, K Segnestam, Dov Weinberger … (2002)

Experimental and clinical studies suggest that GH and IGF-I may be involved in neovascularization of the retina in diabetes and retinopathy of prematurity. However, the role of GH and IGF-I has not been well established in normal retinal vessel development in humans. Therefore, we examined retinal vessel morphology by digital image analysis of ocular fundus photographs in 13 patients with genetic defects of the GH/IGF-I axis and low levels of IGF-I during and after normal retinal vessel growth. Eleven patients (four females and seven males aged 10-49 yr) had defects of the GH receptor (Laron syndrome). One male (20 yr) had a partial deletion of the IGF-I gene, and one female (14 yr) had a single allele deletion of the IGF-I receptor gene. Patients with defects in the GH/IGF-I axis had significantly less retinal vascularization as evidenced by lower number of vascular branching points (median 23, range 16-25), compared with the reference group of 100 normal controls (median 28, range 19-40, P < 0.001). All 13 individuals had vascular branching points below the median of the reference group. This is the first study to provide genetic evidence for a role of the GH and IGF-I system in retinal vascularization in humans.