腕骨发育评价在青春期前儿童生长激素缺乏症诊断中的参考作用

doi:10.11852/zgetbjzz2019-1682

中国儿童保健杂志 ›› 2020, Vol. 28 ›› Issue (7): 733-736.DOI: 10.11852/zgetbjzz2019-1682

腕骨发育评价在青春期前儿童生长激素缺乏症诊断中的参考作用

祝丹, 余文, 徐健

上海交通大学医学院附属国际和平妇幼保健院,上海市胚胎源性疾病重点实验室,上海 200030

收稿日期:2019-11-06 发布日期:2020-07-10 出版日期:2020-07-10
通讯作者: 徐健,E-mail:sonia0616@sjtu.edu.cn;余文,E-mail:yuwencd@163.com.
作者简介:祝丹(1981-),男,上海人,主治医师,硕士学位,主要从事儿童保健工作。
基金资助:
国家自然科学基金(81673189,81373016);上海市教委-高峰高原项目(20172016)

Reference role of carpal bone age in the diagnosis of child growth hormone deficiency

ZHU Dan, YU Wen, XU Jian

International Peace Maternity and Child Health Hospital,School of Medicine,Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases,Shanghai 200030,China

Received:2019-11-06 Online:2020-07-10 Published:2020-07-10
Contact: XU Jian,E-mail:sonia0616@sjtu.edu.cn;YU Wen,E-mail:yuwencd@163.com

摘要/Abstract

摘要： 目的分析腕骨发育评价在生长激素缺乏症诊断中的作用,为生长激素缺乏症的诊疗提供依据。方法选取2018年1月-2019年6月于上海交通大学医学院附属国际和平妇幼保健院儿保门诊完成生长激素激发试验的青春期前儿童82例,其中生长激素缺乏症儿童41例,生活年龄(5.78±1.49)岁,特发性矮小儿童41例,生活年龄(5.17±1.44)岁,调取同期骨龄片,采用中华05骨龄评估方法获取尺桡掌指骨骨龄和腕骨龄,与生活年龄比较后获得尺桡掌指骨、腕骨发育水平(生活年龄-骨龄),用ROC曲线评价两者在预测生长激素缺乏症中的作用。结果生长激素缺乏组儿童腕骨骨龄[(3.88±1.68)岁]显著小于特发性矮小组[(4.75±1.47)岁],差异有统计学意义(t=2.48,P＜0.05),而两组儿童的尺桡掌指骨骨龄差异无统计学意义(P＞0.05);生长激素缺乏组腕骨发育水平[(1.89±1.05)岁]和尺桡掌指骨发育水平[(1.13±0.78)岁]均显著高于特发性矮小组[(0.41±1.02)岁、(0.33±0.86岁)](t=-4.48、-6.47,P＜0.01);腕骨发育水平与生长激素缺乏症的关联强度(OR=4.208,95%CI:2.246～7.884,P＜0.01)优于尺桡掌指骨发育水平(OR=3.311,95%CI:1.763～6.221,P＜0.01);ROC曲线分析显示腕骨发育水平(AUC:0.840,灵敏度:0.707,特异度:0.854,P＜0.01)预测生长激素缺乏症的能力好于尺桡掌指骨发育水平(AUC:0.746,灵敏度:0.683,特异度:0.756,P＜0.01)。结论腕骨发育水平在生长激素缺乏症的诊断中有一定的参考价值,与尺桡掌指骨相比,腕骨发育水平可能是一个更理想的参考指标。

关键词: 中华05, 骨龄, 腕骨, 腕骨龄, 生长激素缺乏症

Abstract: Objective To analyze the role of carpal bone development evaluation in the diagnosis of growth hormone deficiency (GHD),in order to provide basis of diagnosis and treatment of GHD. Methods A total of 82 prepubescent short-statured children who had completed the growth hormone provocative test in child care clinic of International Peace Maternity and Child Health Hospital were enrolled in this study from January 2018 to June 2019,including 41 cases with GHD at chronological age of (5.78±1.49) years old and 41 cases with idiopathic short stature (ISS) at chronological age of (5.17±1.44) years old.Children's bone age was assessed using China 05 method.The ages of radius,ulna,and short (RUS) bone and carpal bone were compared with the chronological age respectively.ROC curve was used to evaluate its role in predicting GHD. Results The carpal bone age in GHD group [(3.88±1.68) years old]was significantly lower than that in ISS group [(4.75±1.47) years old](t=2.48,P<0.05),while significant difference was not found on RUS bone age between the two groups(P＞0.05).Significant delays in bone maturation were both observed in the GHD group using the carpal bone [(1.89±1.05) years old]and RUS bone [(1.13±0.78) years old]assessments,which were higher than those of ISS group [carpal bone:(0.41±1.02) years old,RUS bone:( 0.33±0.86 )years old](t=-4.48,-6.47,P＜0.05).The correlation between maturation delay and GHD in carpal bone (OR=4.208,95%CI:2.246-7.884, P＜0.01) was stronger than that in RUS bone (OR=3.311,95%CI:1.763-6.221, P＜0.01).ROC curve analysis showed that GHD was moderately predicted by the degree of carpal bone maturation delay (AUC=0.840,sensitivity:0.707,specificity:0.854, P＜0.01),and its prediction ability was better than that of RUS bone (AUC=0.746,sensitivity:0.683,specificity:0.756,P＜0.01). Conclusion s Hand bone maturation is helpful for the diagnosis of GHD in preadolescent children.Compared with RUS,carpal bone maturity may be a better reference index for the diagnosis of GHD.

Key words: China 05, bone age, skeleton age, carpal bone, growth hormone deficiency

中图分类号:

R725.8

祝丹, 余文, 徐健. 腕骨发育评价在青春期前儿童生长激素缺乏症诊断中的参考作用[J]. 中国儿童保健杂志, 2020, 28(7): 733-736.

ZHU Dan, YU Wen, XU Jian. Reference role of carpal bone age in the diagnosis of child growth hormone deficiency[J]. journal1, 2020, 28(7): 733-736.

参考文献

[1] 中华医学会儿科学分会.儿科内分泌与代谢性疾病诊疗规范[M].北京:人民卫生出版社,2016:21-26.
[2] Tritos NA,Klibanski A.Effects of growth hormone on bone[J].Prog Mol Biol,2016,138:193-211.
[3] 中华医学会儿科学分会内分泌遗传代谢学组.矮身材儿童诊治指南[J].中华儿科杂志,2008,46(6):428-430.
[4] 中华人民共和国国家体育总局,TY/T3001-2006.中国青少年儿童手腕骨成熟度及评价方法[S].2006.
[5] 赵咏梅,毛萌.GH-IGF-1轴的作用机制[J].四川医学,2005,26(7):808-810.
[6] Even L,Andersson B,Kriström B,et al.Role of growth hormone in enchondroplasia and chondral osteogenesis:evaluation by X-ray of the hand[J].Pediatr Res,2014,76:109-114.
[7] Aghajanian P,Xing W,Cheng S,et al.Epiphyseal bone formation occurs via thyroid hormone regulation of chondrocyte to osteoblast transdifferentiation[J].Sci Rep,2017,7:10432.
[8] Lui JC,Nilsson O,Baron J.Recent research on the growth plate:Recent insights into the regulation of the growth plate[J].J Mol Endocrinol,2014,53(1):1-9.
[9] Felicio JS,Jana LC,Moraes MA,et al.Diagnosis of idiopathic GHD in children based on response to rhGH treatment:The importance of GH provocative tests and IGF-1[J].Front Endocrinol(Lausanne),2019,10:638.
[10] Guzzetti C,Ibba A,Pilia S,et al.Cut-off limits of the peak GH response to stimulation tests for the diagnosis of GH deficiency in children and adolescents:study in patients with organic GHD[J].Eur J Endocrinol,2016,175:41-47.
[11] Tanner JM,Healy MJR,Goldstein H,et al.Assessment of skeletal maturity and prediction of adult height(TW3 method)[M].3rd ed.London:Academic Press,2001:1-49.
[12] Cundall DB,Brocklebank JT,Buckler JM.Which bone age in chronic renal insufficiency and end-stage renal disease?[J].Pediatr Nephrol,1988,2(2):200-204.
[13] Sun XT,Easwar TR,Cielo B,et al.Comparison of bone age delay and recovery in Meyer dysplasia and Legg-Calv -Perthes disease:a pilot study[J].J Orthop Sci,2010,15:746-752.
[14] 吴冯胜,田文,赵俊会,等.Poland综合征手部不同类型骨骼的发育特征[J].中华外科杂志,2016,54(7):508-512.
[15] Bull RK,Edwards PD,Kemp PM,et al.Bone age assessment:a large scale comparison of the Greulich and Pyle,and Tanner and White-house (TW2) methods[J].Arch Dis Child,1999,81:172-173.
[16] 张绍岩.中国人手腕部骨龄标准-中华05及其应用[M].北京:科学出版社,2015:43-44.

腕骨发育评价在青春期前儿童生长激素缺乏症诊断中的参考作用

Reference role of carpal bone age in the diagnosis of child growth hormone deficiency

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