目的 分析骨龄与年龄的差值(BAD)在不同年龄儿童的分布特点,探讨超重和肥胖儿童骨龄发育异常的相关性。方法 对2010年1月-2020年12月在首都儿科研究所附属儿童医院保健门诊体检的21 699名6~18岁儿童进行体格评价和中国人手腕骨发育标准(CHN)法骨龄评估。以WHO推荐的界值点将体重指数(BMI)分为正常组、超重组和肥胖组。比较BAD在不同年龄不同营养状况儿童的分布特点,探讨超重肥胖儿童骨龄提前的关键时点。结果 就诊儿童以6～12岁学龄期儿童为主。男童占48.6%,女童占51.4%。正常、超重和肥胖儿童BAD>1的检出率比较,差异均具有统计学意义(χ2=1 703.70,P<0.05),超重及肥胖组儿童BAD均值在多个年龄均大于正常组,6~11岁肥胖男童及6~10岁肥胖女童BAD均值>1。肥胖男童在6～12岁与13～15岁组之间BAD差异有统计学意义(t=9.47,P<0.05),且6~12岁肥胖组男童BAD均值>1。超重及肥胖女童在6～12岁与13～15岁组间BAD差异均有统计学意义(t=9.695、13.118,P<0.05),且6~12岁超重及肥胖组BAD均值>1。结论 6～12岁儿童的BAD明显大于13～15岁儿童,且超重和肥胖儿童的BAD明显大于正常儿童,说明超重和肥胖儿童骨龄加速在6～12岁就已开始,骨龄提前对儿童正常的生长发育及终身高的影响较大,应引起重视并给予干预。
Abstract
Objective To observe the distribution of difference between bone age and age (BAD) in children at different age stages, and to explore the correlation betweenoverweight and obese children with abnormal bone age development. Methods Totally 21 699 children and adolescents aged 6 to 18 years, who took physical examination in the Affiliated Children's Hospital Capital Institute of Pediatrics from January 2010 to December 2020, were enrolled. The bone age was evaluated by CHN method on left hand radiographs. According to the cut-off point recommended by WHO, the subjects were classified into normal group, overweight and obesity groups. The distribution characteristics of BAD in children with different ages and nutritional status were analyzed. The key time point of bone age advance in overweight and obese children was evaluated. Results The children were mainly school-age children aged 6—12 years, of whom 48.6% were boys and 51.4% were girls. The detection rate of BAD >1 in normal, overweight and obese children was statistically significant (χ2=1 703.70, P<0.05). The average value of BAD in overweight and obese children was higher than that in normal children among most age groups, and the average value of BAD was higher than 1 in 6- to 11-year-old obese boys and 6- to 10-year-old obese girls. There was significant difference in average value of BAD between 6- to 12-year-old boys and 13- to 15-year-old boys in obesity groups (t= 9.47, P<0.05), and the average BAD of 6- to 12-year-old boys was higher than 1. There were significant differences in BAD between girls aged 6 to 12 years and 13 to15 years in overweight and obese group (t=9.695, 13.118, P<0.05), and the average BAD of 6—12 years old girls in overweight and obesity group were higher than 1. Conclusion The BAD of overweight and obese children is significantly obvious than that of normal children, and the BAD of 6- to 12-year-old children is the most obvious. Early bone age has a strong influence on children's normal growth and final height, which should be paid more attention and intervention.
关键词
骨龄 /
骨龄和年龄的差值 /
超重和肥胖
Key words
bone age /
the difference between bone age and age /
overweight and obesity
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参考文献
[1] 张亚钦,李辉.2015年中国九市七岁以下儿童体格发育调查[J].中华儿科杂志,2018,56(3):192-199.
[2] 王烁,董彦会,王政和,等. 1985—2014年中国7～18岁学生超重与肥胖流行趋势[J].中华预防医学杂志,2017,65(4):300-305.
[3] 高海涛,李阳,李辉.不同营养状况下儿童青少年骨龄发育提前或落后的风险分析[J].中国循证儿科杂志,2020,15(2):114-117.
[4] 刘华.3～10岁儿童体成分增速对骨龄发育的前瞻性研究[J].中华实用儿科临床杂志,2017,32(23):1806-1809.
[5] de Groot CJ, van den Berg A, Ballieux BEPB, et al. Determinants of advanced bone age in childhood obesity[J].Horm Res Paediatr, 2017,87(4):254-263.
[6] Stovitz SD, Demerath EW, Hannan PJ, et al. Growing into obesity: patterns of height growth in those who become normal weight, overweight, or obese as young adults[J].Am J Hum Biol, 2011, 23(5):635-641.
[7] 中华医学会儿科学分会内分泌遗传代谢学组,《中华儿科杂志》编辑委员会.中枢性性早熟诊断与治疗共识(2015)[J].中华儿科杂志,2015,53(6):412-418.
[8] 朱翔,罗冬梅. 不同骨龄测定方法在青少年乒乓球运动员中的比较[J].中华骨质疏松杂志,2016,22(11):1430-1434.
[9] 李辉, 季成叶, 宗心南,等. 中国0～18岁儿童,青少年身高,体重的标准化生长曲线[J].中华儿科杂志, 2009, 47(7):487-492.
[10] 武苏,汪素美,朱子阳,等. 2132例矮小症患儿病因及骨龄分析[J].临床儿科杂志,2015,33(8):730-733.
[11] Artioli TO, Alvares MA, Carvalho Macedo VS, et al. Bone age determination in eutrophic, overweight and obese Brazilian children and adolescents: a comparison between computerized BoneXpert and Greulich-Pyle methods[J].Pediatr Radiol, 2019,49(9):1185-1191.
[12] Godfrey DA,Umapathy P, Ravichandran L, et al. Association of bone age with overweight and obesity in children in the age group of 8 to 11 years[J].Inter J Contemp Pediatr, 2016.doi:10.18203/2349-3291.ijcp20161882.
[13] Lee HS, Shim YS,Jeong HR, et al. The association between bone age advancement and insulin resistance in prepubertal obese children[J].Exp Clin Endocrinol Diabetes, 2015,123(10):604-607.
[14] 于波,王俊祺,王伟,等. 雌二醇对大鼠生长板软骨细胞C型利钠肽及胰岛素样生长因子1表达的影响[J].上海交通大学学报(医学版),2017,60(8):1074-1078.
[15] Denzer C, Weibel A, Muche R, et al. Pubertal development in obese children and adolescents[J].Int J Obes (Lond), 2007,31(10):1509-1519.
[16] Cardenas-Vargas E,Nava JA, Garza-Veloz I,et al.The influence of obesity on puberty and insulin resistance in mexican children[J].Int J Endocrinol, 2018,2018:7067292.
[17] BurtSolorzano CM, McCartney CR. Obesity and the pubertal transition in girls and boys[J].Reproduction, 2010,140(3):399-410.
[18] Kaplowitz PB. Link between body fat and the timing of puberty[J].Pediatrics, 2008,121 (Suppl 3):208-217.
[19] He Q , Karlberg J. BMI in childhood and its association with height gain, timing of puberty, and final height[J].Pediatric Research, 2001, 49(2):244-251.
[20] Johnson W, Stovitz SD, Choh AC, et al. Patterns of linear growth and skeletal maturation from birth to 18 years of age in overweight young adults[J].Int J Obes (Lond), 2012,36(4):535-541.
基金
首都卫生发展科研专项(2020-2-2104);北京市属医学科研院所公益发展改革试点项目(2019-11);首都儿科研究所所级基金(QN-2020-09)
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