儿童生长矮小原因临床多因素分析

Clinical multifactorial analysis of causes of stunted growth in children

目的分析儿童生长矮小的临床常见原因,为诊疗提供依据。方法采用1∶2配对病例对照研究,采用自制的问卷调查表对2016年1月~2017年7月于潍坊医学院附属医院儿科门诊就诊的76例生长矮小儿童(病例组)和152例健康检查的儿童(对照组)进行调查,测量身高、体重,完善血常规、生长激素测定、甲功三项、左手腕关节X光片、微量元素等检查,应用卡方检验、Logistic回归模型分析影响儿童生长矮小的原因。比较两组儿童微量元素的水平变化。结果通过卡方检验对各因素进行筛选,生长激素水平低于正常、父母矮小、宫内生长发育迟缓、父母有青春期发育延迟史、主带者文化水平高中以下、反复呼吸道感染、敏感体质、每日被动吸烟大于2h、每周体育锻炼少于3h、房屋有装修搬迁史、睡眠欠佳、饮食欠佳、不完全性早熟、有抽风史或确诊癫痫、有头部外伤或生后窒息史等因素有统计学意义(P<0.05)。将上述因素进行多因素Logistic回归分析,进入回归模型的危险因素有生长激素低于正常、父母矮小、宫内生长发育迟缓、主带者文化水平高中以下、敏感体质、反复呼吸道感染、睡眠欠佳、饮食欠佳、房屋有装修搬迁史。病例组血铅水平高于对照组,差异有统计学意义(P<0.05),病例组血锌、钙、铁、镁水平均低于对照组,差异有统计学意义(P<0.05)。结论儿童生长矮小受遗传与环境共同影响,其中生长激素低于正常、父母矮小、宫内生长发育迟缓、主带者文化水平高中以下、敏感体质、反复呼吸道感染、睡眠欠佳、饮食欠佳、房屋有装修搬迁史为主要影响因素。微量元素异常也是导致儿童生长矮小的因素之一。

Objective To analyze the clinical common causes of stunted growth in children,and to provide evidence for diagnosis and treatment. Methods A 1∶ 2 matched case-control study was used. A self-made questionnaire was used to study 76 children with short growth from January 2016 to July 2017 in the pediatric outpatient clinic of affiliated Hospital of Weifang Medical University. And 152 healthy children,the height,weight,blood routine,growth hormone,nail function three items,left wrist joint X ray and trace elements were measured. Chi square test and Logistic regression model were used to analyze the causes of stunted growth in children. The levels of trace elements in the two groups were compared. Results All the factors were screened by chi square test,growth hormone levels were below normal,parental dwarfism,intrauterine growth retardation,parents had a history of delayed puberty,with the main tape player cultural under the level of high school,recurrent respiratory tract infection,Sensitive constitution,passive smoking more than 2 hours every day,exercised less than 3 hours every week,the house had the history of decoration and removal,poor sleep,poor diet,incomplete precocious puberty,had a history of convulsions or epilepsia,had a head injury or asphyxia had statistically significant（ P〈0. 05）. The above factors were analyzed by multi factor Logistic regression,and the risk factors into the regression model were growth hormone levels were below normal,parents had a history of delayed puberty,intrauterine growth retardation,with the main tape player cultural under the level of high school,sensitive constitution,recurrent respiratory tract infection,poor sleep,poor diet,the house had the history of decoration and removal. The level of blood lead in the case group was higher than that in the control group,the difference was statistically significant（ P〈0. 05）. Blood zinc,calcium,iron and magnesium in the case group were lower than those in the control group,the difference was statistically significant（ P〈0. 05）. Conclusion The growth of small dwarf are influenced by genetic and environmental and growth hormone levels are below normal,parents have a history of delayed puberty,intrauterine growth retardation,with the main tape player cultural under the level of high school. Sensitive constitution,recurrent respiratory tract infection,poor sleep,poor diet,the house have the history of decoration and removal are the main influencing factors. Trace element anomaly is one of the factors leading to the growth of children with short stature.