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。
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.
关键词
中华05 /
骨龄 /
腕骨 /
腕骨龄 /
生长激素缺乏症
Key words
China 05 /
bone age /
skeleton age /
carpal bone /
growth hormone deficiency
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基金
国家自然科学基金(81673189,81373016);上海市教委-高峰高原项目(20172016)
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