GH/IGFs轴功能检测在矮小症儿童病因诊断中的应用及其临床意义

Application of GH/IGFs axis function detection in the etiological diagnosis of short stature children and its clinical significance

目的:探讨生长激素-胰岛素样生长因子(GH/IGFs)轴功能检测在矮小症儿童病因诊断中的应用及其临床价值。方法:选择青春发育前期(按Tanner分期P1期)矮小症儿童90例,设为观察组;选取健康儿童50名,设为对照组。检测观察组和对照组儿童的血清胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平,对观察组患儿予以GH激发试验,进行病因诊断,分为GH完全缺乏(CGHD)组、GH部分缺乏(PGHD)组、特发性矮小症(ISS)组。分析血清IGF-1、IGFBP-3诊断矮小症的敏感度、特异度、准确度。结果:根据GH激发试验结果分组,CGHD组22例,PGHD组36例,ISS组32例。CGHD组、PGHD组、ISS组血清IGF-1、IGFBP-3均明显低于对照组(P<0.01);CGHD组血清IGF-1、IGFBP-3水平均明显低于PGHD组、ISS组(P<0.01)。以血清IGF-1<52.8 ng/mL为判定值,诊断CGHD的灵敏度、特异度和准确度分别为81.82%、100.00%、95.56%;以血清IGFBP-3<3.12μg/mL为判定值,诊断CGHD的灵敏度、特异度和准确度分别为100.00%、75.00%、81.11%。结论:GH/IGFs轴功能检测在矮小症儿童病因诊断中具有较高的临床价值,血清IGF-1、IGFBP-3检测可能有助于CGHD的初筛,结合GH激发试验可能更有助于PGHD、ISS的确诊。

Objective:To explore the clinical application value of growth hormone-insulin-like growth factors(GH/IGFs)axis function detection in the etiological diagnosis of short stature children.Methods:Ninety children with short stature in the pre-puberty stage(P1 by Tanner stage)and 50 healthy children were divided into the observation group and control group,respectively.The levels of serum insulin-like growth factor-1(IGF-1)and insulin-like growth factor binding protein-3(IGFBP-3)in two groups were measured.The pathogenesis in the observation group were diagnosed using GH challenge test,and the observation group was divided into the complete GH deficiency(CGHD)group,partial GH deficiency(PGHD)group and idiopathic short stature(ISS)group.The sensitivity,specificity and accuracy of serum IGF-1 and IGFBP-3 in the diagnosis of short stature were analyzed.Results:According to the results of GH challenge test,there were 22 patients in CGHD group,36 patients in PGHD group and 32 patients in ISS group.The serum levels of IGF-1 and IGFBP-3 in CGHD group,PGHD group and ISS group were significantly lower than those in control group(P<0.01),and the serum levels of IGF-1 and IGFBP-3 in CGHD group were significantly lower than those in PGHD group and ISS group(P<0.01).With the serum level of IGF-1<52.8 ng/mL as the judgment value,the sensitivity,specificity and accuracy of CGHD diagnosis were 81.82%,100.00%and 95.56%,respectively.With the serum level of IGFBP-3<3.12μg/mL as the judgment value,the sensitivity,specificity and accuracy of CGHD prognosis were 100.00%,75.00%and 81.11%,respectively.Conclusions:The GH/IGF axis function detection has high clinical value in the etiological diagnosis of children with short stature.The detection of serum IGF-1 and IGFBP-3 may contribute to the primary screening of CGHD,and which combining with GH challenge test may be more helpful to the diagnosis of PGHD and ISS.