骨代谢指标在特发性身材矮小儿童骨生长发育评价体系中的应用价值

Value of bone metabolization indexes in evaluating system of bone growth in idiopathic short stature children

目的通过检测特发性身材矮小(ISS)儿童血清胰岛素样生长因子1(IGF-1)、骨碱性磷酸酶(BAP)及骨钙素(OC)水平,探讨ISS儿童骨骼生长的特点以及所测指标在ISS儿童骨生长发育评价体系中的应用价值。方法ISS儿童108例及正常对照组儿童100例,分为青春期前组及青春期组;测定其身高、体质量,体质量指数及身高标准差得分(HtSDS)4项形态指标,采用CHN法评定左侧手、腕部骨化指标,计算骨龄;采用酶联免疫吸附(ELISA)法测定其血清IGF-1、BAP及OC水平。结果①青春期前ISS组血清IGF-1、BAP及OC平均水平为(145.33±46.35)μg/L、(89.91±26.94)U/L及(60.96±18.46)μg/L,青春期前正常组为(216.24±62.18)μg/L(、162.15±36.35)U/L及(74.59±26.12)μg/L;青春期ISS组血清IGF-1、BAP及OC水平平均为(210.35±35.98)μg/L、(146.32±30.23)U/L及(59.86±21.85)μg/L,正常组为(381.65±38.72)μg/L、(146.32±30.23)U/L及(94.54±25.37)μg/L,ISS组血清IGF-1、BAP及OC水平均明显低于正常对照组,差异均有统计学意义(P<0.01);②ISS组儿童血清BAP及OC水平与IGF-1及HtSDS存在正相关关系(均P<0.05)。结论①ISS儿童存在生长激素(GH)-IGF-1轴功能异常,骨骼生长动力不足,从而导致以成骨细胞为中心环节的骨塑造和再造能力低于正常儿童;②血清BAP、OC水平能反映ISS儿童的骨骼生长发育状况,可以作为生长及疗效判定的监测指标。

Objective The concentrations of the serum insulin-like growth factor-1 （IGF-1）, bone specific alkaline phosphatase （BAP） and osteocalcin （OC） were measured in the children of idiopathic short stature （ISS） and for the status of bone growth and the value of these indexes in the system of bone growth in idiopathic short stature children. Methods 108 ISS and 100 normal children were divided into two groups,and their body height,body mass,body mass index and body height standard deviation（HtSDS） were measured. Left hand and wrist were measured with CHN way for bone age. Serum IGF-1 ,BAP and OC were measured by enzyme linked immunosorbent assay （ELISA）. Results ①IGF-1,BAP and OC in ISS group of preadolescence were （145.33±46.35） μg/L,（89.91±26.94） U/L and （60.96±18.46） μg/L,but those of normal children were （216.24±62.18） μg/L,（162.15±36.35） U/L and （74.59±26.12） μg/L. In ISS group of adolescence IGF-1, BAP and OC were （210.35±35.98） μg/L, （146.32±30.23） U/L and （59.86±21.85） μg/L and those in normal group were （381.65±38.72） μg/L, （146. 32±30. 23） U/L and （94.54± 25.37） μg/L. ISS group showed significant lower levels of IGF-1, BAP and OC than control group （ P〈0.01）.② There was positive correlation between IGF-1, HtSDS and both levels of BAP and OC in ISS group （all P d0.05）. Conclusion ①There is disorder in growth hormone-IGF-1 axis of the children with ISS,which leads to the growth power and the ability of osteoblast in ISS lower than the normal children in the process of bone modeling and remodeling. ②The serum levels of OC and BAP indicate the state of bone growth and development can be regarded as a potential serological indicator of growth and certifying curative effect.