Application of exercise stimulation test combined with levodopa challenge test in screening growth hormone deficiency
Objective To investigate the value of exercise stimulation test(EST)combined with levodopa challenge test(LCT)to the screening of growth hormone deficiency(GHD),and to establish a GHD predictive nomogram model.Methods Sixty-sevenchildren with short stature underwent GHD screening in the People's Hospital of Dongying from December,2020 to December,2023.The serum growth hormone(GH)level was detected before and immediately after EST as well as 30,60,90 and 120 min after LCT by chemiluminescence method.Insulin stimulation test was performed in patients with serum GH level＜10 μg/L at all time points.According to the results of three tests,67 children were divided into GHD group(n=39)and non-GHD group(n=28).The gender,age,body mass index,standard deviation score of height,sitting height,bone age,blood routine examination results,electrolyte,lipid,liver function,kidney function,thyroid function,myocardial enzyme,fasting plasma glucose,glycosylated hemoglobin,insulin growth factor 1,and serum GH level immediately after EST and at each time point were compared between two groups.ROC curve was plotted to evaluate the diagnostic efficiencies of serum GH level immediately after EST combined with GH level at each time point after LCT on diagnosing GHD.The serum GH level with good diagnostic efficiency of GHD(AUC≥0.8)was selected to construct a nomogram model for predicting GHD,and ROC curve was used to verify the predictive efficiency of nomogram model on GHD.Results(1)There were no significant differences in the gender,age,body mass index,standard deviation score of height,sitting height,bone age,blood routine,electrolyte,lipid,liver function,kidney function,thyroid function,myocardial enzyme,fasting plasma glucose,glycosylated hemoglobin,and insulin growth factor 1 level between two groups(P＞0.05).(2)There was no significant difference in serum GH level between GHD group[0.578(0.186,1.689)μg/L]and non-GHD group[0.729(0.277,1.950)μg/L]before EST(P＞0.05).The serum GH level immediately after EST and 30,60,90 and 120 min after LCT were lower in GHD group[2.830(1.235,4.936),1.641(0.511,2.890),2.160(0.606,3.680),1.620(0.650,3.067),1.350(0.520,2.796)μg/L]than those in non-GHD group[10.030(1.450,14.630),13.290(1.325,10.900),6.673(1.838,10.495),13.600(1.272,6.615),2.855(1.045,5.060)μg/L](P＜0.05).(3)The AUCs of GH level immediately after EST combined with GH level 30,60,90 and 120 min after LCT for diagnosing GHD were 0.758(95％CI:0.648-0.910,P＜0.001),0.816(95％CI:0.704-0.927,P=0.005),0.784(95％CI:0.667-0.900,P＜0.001),and 0.837(95％CI:0.585-0.864.P=0.002),the sensitivities were 92.3％,87.1％,89.7％and 82.1％,and the specificities were 67.8％,71.4％,57.1％and 67.8％,respectively.(4)The serum GH levels immediately after EST and 60 and 120 min after LCT were selected to construct the GHD nomogram prediction model,the AUC for diagnosing GHD was 0.876(95％CI:0.755-0.996,P＜0.001),the sensitivity was 84.0％,and the specificity was 85.0％.Conclusion The serum GH level immediately after EST combined with GH level 60 and 120 min after LCT is of high value to the diagnosis of GHD,and the nomogram model has a high value to the prediction of GHD.
nanosomiagrowth hormoneexercise stimulation testlevodopa challenge test
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