TW法在女性患儿特发性性早熟尺桡骨和手短骨骨龄评价的诊断性试验研究

Diagnostic Test of TW System Bone Age of the Radius Ulna and Short of Bones in Chinese Girls With Idiopathic Precocious Puberty

目的比较TW_2法英国人标准(TW_2)、TW_2法中国人南方标准(TW_2CH)和TW_3法尺桡骨和手短骨(radius ulna and short bones,RUS)骨龄评价方法对特发性性早熟(idiopathic precocious puberty,IPP)女性患儿的诊断价值。方法以1995年1月到2002年8月约8年间在四川大学华西第二医院儿科门诊和妇科生殖内分泌门诊就诊并确诊为特发性性早熟女性患儿55例为病例组;对照组(n=83)为同期在本院因10岁以后月经初潮,8～10岁体重偏轻、正常、偏重而行骨龄检查的女性儿童。本研究采用WHO推荐使用的美国国家卫生统计中心(NCHS)身高、体重发育参考标准,回顾性分析初诊时左手腕X射线摄片,用TW骨龄评分法盲法分期,用TW_2法、TW_2CH法和TW_3法分别评价尺桡骨和手短骨骨龄及其相应百分位,每个系统分5个工作点,骨龄以百分位(P)表示:①>P97;②>P90;③>P75;④>P50;⑤≤P50。结果敏感度(Sen)和特异度(Spe)都比较高的有以下4个工作点:①TW_2CH">P90";②TW_3">P90";⑧TW_2CH">P75";④TW_3">P75"。三条受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)下相对面积最大的是TW_2CH(0.942±0.019),其次是TW_3法(0.886±0.028),最小的是TW_2法(0.766±0.040)。结论用TW系列三种尺桡骨和手短骨骨龄评价特发性性早熟女性患儿骨龄都有诊断价值,TW_2CH法的诊断价值最高,TW_3和TW_2的诊断价值为中等,其中TW_2法的诊断价值最低。

Objective To compare the TW2, TW2CH and TW3 methods in Chinese girls with idiopathic precocious puberty （IPP） for the radius ulna and short bones （RUS） bone age. Methods 55 girls （aged from 3.2 to 9.9 years） with idiopathic precocious puberty were admitted in the Department of Pediatrics and Gynecology and Obstetrics, West China Second University Hospital from January 1995 to August 2002 as the test group. Among them,.36 cases started breast development before age 8 （aged from 1. 50 to 7.90 years）. 20 girls had menarche before age 10 （aged from 5.00 to 9.75 years）. The control group includes： （1） 14 girls started menarche after age 10 （11.45 ±1.05） years; （2）25 girls who started menarche aged from 8 to 10 （9.20±0.67） years with lower weight; （3） 32 giris who started menarche aged from 8 to 10 （9.11±0.74） years with normal weight; （4） 12 girls who started menarche aged from 8 to 10 （9.61 ± 0.66） years with overweight. Their left hand-wrist radiographs taken at their first visit were retrospectively analyzed. Bone age was staged single-blind using the radius ulna and short bones. TWz London standard radius ulna and short bones （TW2）, TW2 in the south of China standard radius ulna and short bones （TW2CH） and TW3 systems were used in bone age estimation. Five decision thresholds were recorded for each system. They were 〉 97^th percentile, 〉 90^th percentile, 〉 75^th percentile, 〉50^th percentile and ≤50^th percentile. Results The following four thresholds were relatively high ira both sensitivity and specificity： （1）〉90^th percentile of TW2CH （Sen= 0. 836, Spe= 0. 915）, by which there were 16 cases of missed diagnosis and misdiagnosis, with a diagnosis accuracy of 88.41%; （2）〉90^th percentile of TWa（Sen=72.73%, Spe=86.75%）, by which there were 26 cases of missed diagnosis and misdiagnosis, with a diagnosis accuracy of 81. 16%; （3）〉75^th percentile of TW2CH, by which there were 28 cases of missed diagnosis and misdiagnosis, with a diagnosis accuracy of 79.71% ; （4）〉75^th percentile of TW3, by which there were 30 cases of missed diagnosis and misdiagnosis, with a diagnosis accuracy of 78.26%. Area under the receiver operating characteristic curve （AUR） with TW2CH： 0. 942± 0. 019 （95% CI 0. 905-0. 978）. Area under the receiver operating characteristic curve with TW3： 0. 886±0. 028 （95% CI 0. 831-0. 941）. Area under the receiver operating characteristic curve with TW2 is the smallest ： 0. 766± 0. 040 （95%CI 0. 688-0. 843）. Conclusion To evaluate bone age and its percentile with TW-RUS system, the TW2CH has the highest value in diagnosing idiopathic precocious puberty. TW3 and TW2 systems are moderate. The TW2 Britisher standard radius ulna and short bones is the lowest.