精氨酸与可乐定激发试验对儿童生长激素缺乏症的诊断价值

Diagnostic Value of Provocative Test for Growth Hormone Deficiency in Children

目的 评价生长激素（GH） 精氨酸与可乐定激发试验对儿童生长激素缺乏症（GHD）的诊断价值.方法 选取166例身材矮小患儿,均符合身材矮小诊断标准,无骨代谢、糖尿病等其他内分泌代谢疾病.对患儿均进行GH精氨酸与可乐定激发试验,采用化学发光法进行GH检测.以激发试验后测得的GH最高值为峰值,峰值≥10 μg/L为GH不缺乏,激发试验阳性;10 μg/L〉峰值≥5 μg/L为GH部分缺乏;峰值〈5 μg/L者为GH完全缺乏,激发试验均为阴性.结果 激发试验的阳性率精氨酸为9.0%（15/166）,可乐定为31.3%（52/166）,而精氨酸＋可乐定为36.1%（60/166）.精氨酸激发的峰值多出现在30 min（100/166）,可乐定激发的峰值出现在60～90 min（153/166）,两种药物GH激发试验显示GH完全缺乏的为24.1%（40/166）.结论 可乐定激发试验阳性率优于精氨酸激发试验,两种药物激发试验联合使用将提高GH缺乏症诊断的准确性.

Objective To assess the stimulating effect of arginine and clonidine on pituitary growth hormone（GH） secretion in growth hormone defieiency（GHD） children. Methods 166 cases of short stature children excluding other disease were screened with diagnosis standard. The subjects were underwent arginine and clonidine provocation test. Serum GH levels were determined with chemiluminescent. The highest GH value after provocation was termed as the peak value. The judging standard was as follows ..the peak value was 10μg/L or above as provocation test positive （no deficiency of GH）,5μg/L or above as GH part deficiency;lower than 5μg/L as GH deficiency. Results The short stature children with a GH peak value of 10μg/L or above accounted for 9.0%（15/166） by arginine provocation test,but the clonidine had 31.3%（52/ 166）. The arginine and clonidine together had 36.1% （60/166）. The peak value of arginine provocation test mostly focused on time 30 min（100/166） after overdose,but clonidlne provocation test mostly period of 60 to 90 rain（153/166）. Conclusion The diagnostic value of clonidine provocation test is better than arginine test. The provocative test using clonidine combined with arginine will increase the accurate of diagnosis for the growth hormone deficiency.