预测特发性矮小症成年身高方法比较研究

The clinical value of different methods of predicting adult height applied to patients with idiopathic short stature

目的比较3种不同预测成年身高(PAH)的方法(B-P法、TW3法和曲线法)对特发性矮小症(ISS)患儿的预测价值。方法 1999—2002年上海交通大学医学院附属瑞金医院儿内科就诊的ISS患儿32例,其中男25例,女7例;就诊时平均年龄(11.9±1.9)岁;均未接受任何药物助长治疗,平均年龄对应身高标准差分值(HtSDSCA)为-2.62±0.63,进行终身高随访。采用Greulich-Pyle图谱法(G-P法)和TW3-RUS法评价骨龄成熟程度,并作对应骨龄预测成年身高(PAH)。通过单因素方差分析和直线相关分析,比较不同方法预测效率及其影响因素。结果 G-P法和TW3法评判ISS患儿BA差异有统计学意义(t=4.33,P<0.01)。B-P法、TW3法和曲线法所得PAH间差异无统计学意义(F=0.24,P>0.05);B-P法、TW3法及曲线法预测值与实际终身高(FAH)均呈正相关(r=0.892、0.740、0.821,P<0.01)。在BA<10岁的男性患儿中,3种预测方法所得PAH值与FAH差值间的方差分析差异无统计学意义(P>0.05),但TW3法的预测偏差较另两种方法大。G-P图谱粗读骨龄平均为(9.93±2.25)岁,与细读骨龄(10.55±2.23)岁间差异有统计学意义(P<0.01),其对应骨龄的B-P法预测成年身高两者差异存在统计学意义(P<0.01)。结论 3种不同预测成年身高方法(B-P法、TW3法和曲线法)均能适用于ISS的临床诊治及随访,其中B-P法和曲线法预测效率相似,且略优于TW3法。但在临床应用中还需注意用于评价骨龄的G-P法的仔细比较,以免影响预测。过小骨龄者须谨慎使用TW3法。

Objective To compare three different PAH methods and analyze their predictive value in idiopathic short stature（ISS） patients .Methods Thirty-two ISS patients were followed up to adult without accepting any treatment for growth, mean age being 11.9 ± 1.9 years-old, mean HtSDS being -2.62 ± 0.63.For each patient.We assessed bone age with G-P and TW3 method, and estimated PAH with corresponding B-P, TW3 and curve method. We compared final adult height （FAH） and the mean value of PAH with each method by single factor analysis of variance and correlations analyze in order to analysis their predictive value and influence factors. Results There was not significant difference in the mean value of PAH with three methods （t = 4.33,P〉0.05）.Significant correlation was found in the FAH and PAH with three methods（P〈0.01）,and the correlation coefficient of FAH and PAH was 0.8918 with B-P method,0.740 with TW3 method and 0.821 with curve method. In boys whose bone age was less than ten years, no significant difference was found in the mean value of PAH with three methods（P〉0.05）.However,the error of prediction with TW3 method was more than other methods. The mean value of bone age based on G-P method roughly（9.93 ± 2.25）was significantly different compared with that based on G-P method carefully（10.54 ± 2.23）,thus the prediction of adult bone age wassignificantly different with corresponding bone age（P〈0.01）.Conclusion All of these three methods of PAH are suitable for ISS patients. Furthermore, predictive efficiency with B-P method is equal to curve method, better than TW3 method. Assessment of BA with G-P method needs to be more careful in order to avoid error. It should be more careful to predict adult height with TW3 method when their bone ages are too low.