目的:多发性硬化症(MS)是中枢神经系统(CNS)的慢性进行性自身免疫性疾病,可引起炎症,脱髓鞘,和轴突变性。胰岛素样生长因子-1(IGF-1)是主要在肝脏和大脑中合成的单链多肽。IGF-1引起神经元和非神经元细胞增殖,生存,和差异化。因此,它可用于治疗神经脱髓鞘疾病,如MS。当前的系统评价和荟萃分析旨在比较MS患者和健康对照组中IGF-1的水平,并研究MS患者和健康对照组之间的IGF结合蛋白(IGF-BP)和生长激素(GH)水平。
方法:在本研究中,我们系统地搜索了PubMed的电子数据库,Scopus,WebofScience(WOS),和谷歌学者,到2022年12月。测量IGF-1,GH,确定了MS患者和血液或脑脊液(CSF)中健康对照的IGFBP-1,IGFBP-2或IGFBP-3。我们计算了标准化平均差异(SMD)来比较IGF-1、GH、MS患者和对照中的IGFBP-1、IGFBP-2或IGFBP-3。
结果:最后,我们纳入了1998年至2018年的11项符合条件的研究.纳入研究的样本量从20到200不等,总样本量为1067人,531名MS患者,和536个健康对照。患者组和对照组的平均年龄分别为38.96岁和39.38岁。患者平均EDSS为4.56。我们发现IGF-1的血液水平(SMD=0.20,95%CI=-0.20至0.59,I2=82.4%,K=8,n=692),IGF-1的CSF水平(SMD=0.25,95%CI=-0.06至0.56,I2=0.0%,K=3n=164),MS患者的GH血液水平并未显着高于对照组(SMD=0.08,95%CI=-0.33至0.49,I2=77.0%K=3,n=421)。此外,IGFBP-1的血液水平(SMD=0.70,95%CI=0.01至1.40,I2=77%,MS病例的K=4,n=255)显着高于对照组。然而,IGFBP-2的血液水平(SMD=0.43,95%CI=-0.34至1.21,I2=64.2%,K=3,n=78)和IGFBP-3的血液水平(SMD=1.04,95%CI=-0.09至2.17,I2=95.6%,K=6,n=443)在患者中没有显着高于对照组。
结论:我们的荟萃分析显示,IGF-1、GH、MS组和健康对照组之间的IGFBP-2和IGFBP-3,除了IGFBP1。然而,我们的系统综述显示,这些研究对IGFBP-3血清水平存在争议.一些研究发现,与健康组相比,MS患者的血清IGFBP-3水平升高,而其他人则表现出下降。
OBJECTIVE: Multiple sclerosis (MS) is a chronic progressive autoimmune disorder of the central nervous system (CNS) that can cause inflammation, demyelination, and axon degeneration. Insulin-like growth factor-1 (IGF-1) is a single-chain polypeptide mainly synthesized in the liver and brain. IGF-1 causes neuronal and non-neuronal cell proliferation, survival, and differentiation. Therefore, it can be used in treating neuro-demyelinating diseases such as MS. The current systematic
review and meta-analysis aims to compare the levels of IGF-1 in MS patients and healthy controls and also investigates IGF binding proteins (IGF-BP) and growth hormone (GH) levels between MS patients and healthy controls.
METHODS: In this study, we systematically searched electronic databases of PubMed, Scopus, Web of Science (WOS), and Google Scholar, up to December 2022. Studies that measured IGF-1, GH, IGFBP-1, IGFBP-2, or IGFBP-3 in MS patients and healthy controls in either blood or cerebral spinal fluid (CSF) were identified. We calculated Standardized mean differences (SMD) to compare levels of IGF-1, GH, IGFBP-1, IGFBP-2, or IGFBP-3 in MS patients and controls.
RESULTS: Finally, we included 11 eligible studies from 1998 to 2018. The sample size of included studies varied from 20 to 200 resulting in a total sample size of 1067 individuals, 531 MS patients, and 536 healthy controls. The mean age of the patient and control groups were 38.96 and 39.38, respectively. The average EDSS among patients was 4.56. We found that blood levels of IGF-1 (SMD = 0.20, 95% CI = -0.20 to 0.59, I2 = 82.4%, K = 8, n = 692), CSF level of IGF-1 (SMD = 0.25, 95% CI = -0.06 to 0.56, I2 = 0.0%, K = 3 n = 164) and blood levels of GH were not significantly higher in MS patients than controls (SMD = 0.08, 95% CI = -0.33 to 0.49, I2 = 77.0% K = 3, n = 421). Moreover, the blood levels of IGFBP-1 (SMD = 0.70, 95% CI = 0.01 to 1.40, I2 = 77%, K = 4, n = 255) were significantly higher in MS cases than in controls. However, the blood levels of IGFBP-2 (SMD = 0.43, 95% CI = -0.34 to 1.21, I2 = 64.2%, K = 3, n = 78) and blood levels of IGFBP-3 (SMD = 1.04, 95% CI = -0.09 to 2.17, I2 = 95.6%, K = 6, n = 443) were not significantly higher in patients than controls.
CONCLUSIONS: Our meta-analysis revealed no significant difference in serum levels of IGF-1, GH, IGFBP-2, and IGFBP-3 between the MS group and healthy controls, except for IGFBP1. However, our systematic
review showed that the studies were controversial for IGFBP-3 serum levels. Some studies found an increase in serum level of IGFBP-3 in MS patients compared to the healthy group, while others showed a decrease.