矮小症患儿血清维生素D、相关元素及其与患儿体格、生长激素、胰岛素样生长因子-1的相关性

Levels of serum vitamin D and related elements in children with dwarfism and their correlation with physique,growth hormone,and insulin-like growth factor-1

目的分析温州市矮小症患儿血清维生素D、相关元素及其与患儿体格、生长激素(GH)、胰岛素样生长因子-1(IGF-1)的相关性。方法选取温州医科大学附属第一医院2017年4月—2020年1月收治的矮小症患儿80例为观察组,另纳入同期该院体检的健康儿童50例为对照组。比较两组儿童的身高、体重、骨龄、维生素D[25-羟维生素D_(3),25(OH)D_(3)]、铁、锌、铜、钙、镁、GH、IGF-1。采用Pearson法分析身高、体重、骨龄、GH、IGF-1与25(OH)D_(3)、铁、锌、铜、钙、镁的相关性;绘制ROC曲线,分析维生素D及相关元素对矮小症的诊断效能。结果观察组的身高、体重、骨龄、GH、25(OH)D_(3)、IGF-1、铁、锌、铜、钙、镁均低于对照组(P<0.05)。观察组的GH、25(OH)D_(3)、IGF-1均低于对照组(P<0.05)。身高与25(OH)D_(3)、铁、锌、铜、钙、镁均呈正相关(r=7.692、7.126、7.068、6.830、7.426和7.309,均P<0.05),体重与25(OH)D_(3)、铁、锌、铜、钙、镁均呈正相关(r=7.321、7.263、6.593、6.829、7.200和6.786,均P<0.05),骨龄与25(OH)D_(3)、铁、锌、铜、钙、镁均呈正相关(r=7.434、7.160、6.710、6.789、7.125和6.940,均P<0.05),GH与25(OH)D_(3)、铁、锌、铜、钙、镁均呈正相关(r=6.779、4.425、4.862、3.837、3.696和4.148,均P<0.05),IGF-1与25(OH)D_(3)、铁、锌、铜、钙、镁均呈正相关(r=6.950、4.796、5.462、4.296、4.474和4.056,均P<0.05);ROC曲线显示,25(OH)D_(3)、铁、锌、铜、钙、镁及联合检测诊断矮小症的AUC分别为0.914(95%CI:0.867,0.960)、0.910(95%CI:0.858,0.961)、0.866(95%CI:0.807,0.925)、0.811(95%CI:0.737,0.886)、0.853(95%CI:0.789,0.917)、0.850(95%CI:0.786,0.914)及0.978(95%CI:0.959,0.997)。25(OH)D_(3)诊断矮小症的敏感性、特异性为86.0%(95%CI:0.812,0.892)和61.3%(95%CI:0.547,0.698),铁诊断矮小症的敏感性、特异性为82.0%(95%CI:0.786,0.858)和53.8%(95%CI:0.482,0.651),锌诊断矮小症的敏感性、特异性为80.0%(95%CI:0.743,0.836)和53.8%(95%CI:0.471,0.639),铜诊断矮小症的敏感性、特异性为78.0%(95%CI:0.647,0.821)和52.5%(95%CI:0.446,0.582),钙诊断矮小症的敏感性、特异性为76.0%(95%CI:0.625,0.790)和51.3%(95%CI:0.419,0.567),镁诊断矮小症的敏感性、特异性为82.0%(95%CI:0.779,0.827)和68.2%(95%CI:0.593,0.740),联合诊断矮小症的敏感性、特异性为94.0%(95%CI:0.869,0.990)和77.5%(95%CI:0.644,0.818)。结论矮小症患儿血清25(OH)D_(3)、铁、锌、铜、钙、镁低下,身高、体重、骨龄、GH、IGF-1与25(OH)D_(3)、铁、锌、铜、钙、镁有关,联合检测有助于诊断矮小症。

Objective To analyze the levels of serum vitamin D and related elements in children with dwarfism in Wenzhou and their correlation with their physique,growth hormone(GH),and insulin-like growth factor-1(IGF-1).Methods Eighty children with short stature admitted to the first affiliated hospital of Wenzhou Medical College from April 2017 to January 2020 were selected as the observation Group,and the other 50 healthy children who had physical examination at the same time were included as the control group.Body information(height,weight,bone age),vitamin D[25(OH)D_(3)],micronutrient(iron,zinc,copper,calcium,magnesium),growth hormone(GH),and insulin-like growth factor-1(Igf-1)were compared between the two groups.Pearson method was used to analyze the correlation of height,weight,bone age,GH level,IGF-1 level with 25(OH)D_(3),iron,zinc,copper,calcium,and magnesium.ROC curve was drawed to analyz the diagnostic efficacy of vitamin D and related elements in dwarfism.Results Comparing of height,weight,bone age,GH,25(OH)D_(3),IGF-1,vegetarian iron,zinc,copper,calcium,and magnesium between the two groups,the observation group was lower than the control group(P<0.05);the observation group was lower than the control group(P<0.05);height was positively associated with 25(OH)D_(3) and trace elements(r=7.692,7.126,7.068,6.830,7.426 and 7.309,all P<0.05);body weight was positively correlated with 25(OH)D_(3) and trace elements(r=7.321,7.263,6.593,6.829,7.200 and 6.786,all P<0.05);bone age was positively associated with 25(OH)D_(3) and trace elements(r=7.434,7.160,6.710,6.789,7.125 and 6.940,all P<0.05);GH was positively associated with 25(OH)D_(3) and trace elements(r=6.779,4.425,4.862,3.837,3.696 and 4.148,all P<0.05);IGF-1 was positively associated with 25(OH)D_(3) and trace elements(r=6.950,4.796,5.462,4.296,4.474 and 4.056,all P<0.05).The ROC curve showed that the AUC of 25(OH)D_(3),iron,zinc,copper,calcium,magnesium and combined detection in the diagnosis of dwarfism were 0.914(95%CI:0.867,0.960),0.910(95%CI:0.858,0.961),0.866(95%CI:0.807,0.925),0.811(95%CI:0.737,0.886),0.853(95%CI:0.789,0.917),0.850(95%CI:0.786,0.914)and 0.978(95%CI:0.959,0.997),respectively.The sensitivity and specificity of 25(OH)D_(3) in the diagnosis of dwarfism were 86.0%(95%CI:0.812,0.892)and 61.3%(95%CI:0.547,0.698);the sensitivity and specificity of iron in the diagnosis of dwarfism were 82.0%(95%CI:0.786,0.858)and 53.8%(95%CI:0.482,0.651);the sensitivity and specificity of zinc in the diagnosis of dwarfism were 80.0%(95%CI:0.743,0.836)and 53.8%(95%CI:0.471,0.639);the sensitivity and specificity of copper in the diagnosis of dwarfism were 78.0%(95%CI:0.647,0.821)and 52.5%(95%CI:0.446,0.582);the sensitivity and specificity of calcium in the diagnosis of dwarfism were 76.0%(95%CI:0.625,0.790)and 51.3%(95%CI:0.419,0.567);the sensitivity and specificity of magnesium in the diagnosis of dwarfism were 82.0%(95%CI:0.779,0.827)and 68.2%(95%CI:0.593,0.740);the sensitivity and specificity of combined diagnosis of dwarfism were 94.0%(95%CI:0.869,0.990)and 77.5%(95%CI:0.644,0.818).Conclusion The levels of serum 25(OH)D_(3),iron,zinc,copper,calcium,and magnesium in children with dwarfism are low.The levels of height,weight,bone age,GH,and IGF-1 are related to the levels of 25(OH)D_(3),iron,zinc,copper,calcium,and magnesium.Combined detection is helpful to diagnose dwarfism.