目的 探讨不同病因矮小症患儿血清生长激素释放肽(Ghrelin)、胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)水平变化及其临床意义.方法 选取2016年1月至2022年1月南通大学附属医院如皋分院收治的212例矮小症患儿,根据不同病因分为生长激素缺乏症组(n=60)、特发性矮小症组(n=46)、Turner综合征组(n=38)、先天性甲状腺功能减退症组(n=32)和宫内发育迟缓组(n=36),另选取同期于本院行体检证实身高同性别、同年龄标准范围内的106例健康儿童作为对照组.比较不同病因矮小症患儿与对照组的人口学特征和骨龄年龄差(bone age difference,BAD)、身高标准差分值(height standard deviation score,Ht SDS)、年生长速率(growth velocity,GV)和生长激素(growth hormone,GH)峰值等生长发育指标及青春前期和青春期的血清Ghrelin、IGF-1水平.采用受试者操作特征(receiver operating characteristic,ROC)曲线分析血清Ghrelin、IGF-1水平对特发性矮小症的鉴别诊断价值.统计学方法采用单因素方差分析、LSD-t检验及x2检验.结果 特发性矮小症组青春期患儿比例为65.2％,明显高于其他4组(P值均＜0.05),其中青春期患儿比例从高至低依次为宫内发育迟缓组(41.7％)、先天性甲状腺功能减退症组(40.6％)、生长激素缺乏症组(35.0％)和Turner综合征组(31.6％);特发性矮小症组BAD为(1.4±0.3)岁,明显高于其他4组(P值均＜0.05),其中BAD值从高至低依次为生长激素缺乏症组[(1.2±0.2)岁]、先天性甲状腺功能减退症组[(1.1±0.2)岁]、Turner综合征组[(0.7±0.1)岁]和宫内发育迟缓组[(0.3±0.1)岁].特发性矮小症组GV值为[(3.7±0.8)cm/年],明显高于其他4组(P值均＜0.05),其中GV值从高至低依次为生长激素缺乏症组[(2.2±0.7)cm/年]、宫内发育迟缓组[(2.1±0.6)cm/年]、先天性甲状腺功能减退症组[(1.7±0.5)cm/年]和Turner综合征组[(1.2±0.4)cm/年].生长激素缺乏症组GH峰值为[(6.4±0.3)μg/L],明显低于其他4组(P值均＜0.05),其中GH峰值从低至高依次为宫内发育迟缓组[(13.4±3.2)μg/L]、Turner综合征组[(14.2±2.1)μg/L]、特发性矮小症组[(14.7±2.5)μg/L]和先天性甲状腺功能减退症组[(15.6±2.9)μg/L].Turner综合征组Ghrelin水平显著高于生长激素缺乏症组、特发性矮小症组、先天性甲状腺功能减退症组和宫内发育迟缓组(P值均＜0.05);先天性甲状腺功能减退症组IGF-1水平显著低于生长激素缺乏症组、特发性矮小症组、Turner综合征组和宫内发育迟缓组(P值均＜0.05).特发性矮小症组青春前期的血清Ghrelin、IGF-1水平均明显低于青春期(P值均＜0.05).ROC曲线分析结果显示,血清Ghrelin、IGF-1鉴别诊断特发性矮小症的曲线下面积(area under the curve,AUC)分别为0.776、0.733,联合检测鉴别诊断特发性矮小症的AUC为0.839,灵敏度为90.0％,特异性为65.6％(P＜0.001).结论 不同病因矮小症患儿血清Ghrelin、IGF-1水平均存在异常表达,特发性矮小症患儿在青春前期和青春期的血清Ghrelin、IGF-1水平差异明显,血清Ghrelin、IGF-1联合检测对特发性矮小症的鉴别诊断具有较好的诊断效能.
Changes of serum growth hormone-releasing peptide and insulin-like growth factor-1 in children with different disease causes of short stature and its clinical significance
Objective To explore the changes of serum growth hormone-releasing peptide(Ghrelin)and insulin-like growth factor-1(IGF-1)in children with different disease causes of short stature and its clinical significance.Method A total of 212 children with short stature admitted to Rugao Branch,Affiliated Hospital of Nantong University were enrolled between January 2016 and January 2022.According to different disease causes,they were divided into growth hormone deficiency group(n=60),idiopathic short stature group(n=46),Turner syndrome group(n=38),congenital hypothyroidism group(n=32)and intrauterine growth retardation group(n=36).A total of 106 healthy children with matched height,gender and age during the same period in same hospital were enrolled as control group.The demographic characteristics,growth and development indexes[bone age difference(BAD),height standard deviation score(Ht SDS),annual growth velocity(GV),growth hormone(GH)],levels of serum Ghrelin and IGF-1 before and during adolescence were compared between children with different disease causes of short stature and control group.The differential diagnosis value of serum Ghrelin and IGF-1 levels in idiopathic short stature was analyzed by receiver operating characteristic(ROC)curve.Statistical methods performed by One-way analysis of variance,LSD-t test,and x2 test.Result The proportion of adolescent children in the idiopathic short stature group was 65.2％,which was significantly higher than that in the other 4 groups(all P＜0.05).The proportion of adolescent children from high to low was intrauterine growth retardation group(41.7％),congenital hypothyroidism group(40.6％),growth hormone deficiency group(35.0％)and Turner syndrome group(31.6％).The BAD of the idiopathic short stature group was(1.4±0.3)years,which was significantly higher than that of the other 4 groups(all P＜0.05).The BAD values from high to low were(1.2±0.2)years in growth hormone deficiency group,(1.1±0.2)years in congenital hypothyroidism group,(0.7±0.1)years in Turner syndrome group and(0.3±0.1)years in intrauterine growth retardation group.The GV of the idiopathic short stature group was(3.7±0.8)cm/year,which was significantly higher than that of the other 4 groups(all P＜0.05).The GV from high to low were(2.2±0.7)cm/year in growth hormone deficiency group,(2.1±0.6)cm/year in intrauterine growth delay group,(1.7±0.5)cm/year incongenital hypothyroidism group,and(1.2±0.4)cm/year in Turner syndrome group.The peak GH value of the growth hormone deficiency group was(6.4±0.3)μg/L,which was significantly lower than that of the other 4 groups(all P＜0.05).The peak GH values from low to high were(13.4±3.2)μg/L in intrauterine growth retardation group,(14.2±2.1)μg/L in Turner syndrome group,(14.7±2.5)μg/L in idiopathic short stature group,and(15.6±2.9)μg/L in congenital hypothyroidism group.Ghrelin level in the Turner syndrome group was significantly higher than that in growth hormone deficiency group,idiopathic short stature group,congenital hypothyroidism group and intrauterine growth retardation group(all P＜0.05).The level of IGF-1 in congenital hypothyroidism group was significantly lower than that in growth hormone deficiency group,idiopathic short stature group,Turner syndrome group and intrauterine growth retardation group(P＜0.05).The levels of serum Ghrelin and IGF-1 in the prepubertal period of idiopathic short stature group were significantly lower than those in adolescence(P＜0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of serum Ghrelin and IGF-1 for differential diagnosis of idiopathic short stature was 0.776 and 0.733,respectively.The AUC of combined detection for differential diagnosis of idiopathic short stature was 0.839,the sensitivity was 90.0％,and the specificity was 65.6％(P＜0.001).Conclusion There are abnormal expressions of serum Ghrelin and IGF-1 in children with different disease causes of short stature.There are significant differences in levels of serum Ghrelin and IGF-1 among idiopathic short stature children before and during adolescence.The combined detection of serum Ghrelin and IGF-1 has good efficiency in the differential diagnosis of idiopathic short stature.
Disease causeDevelopmental stageGrowth hormone releasing peptideInsulin-like growth factor-1Short statureDifferential diagnosis of disease cause
万方数据
