基于北京农村区域儿童骨龄评价标准的适用性分析

Applicability analysis of bone age assessment standards for children in rural areas of Beijing

目的基于北京农村区域儿童探讨不同骨龄评价标准测量的骨龄与实际年龄的差异及适用性。方法该研究为前瞻性研究,研究数据来源于科技部科技基础资源调查专项“中国0~18岁儿童营养与健康系统调查与应用”项目中的北京农村调查点的3~12岁健康儿童于2021年4月拍摄的非优势侧手腕部X线骨龄片。共412例,男226例、女186例,年龄8.6(6.8,10.3)岁。利用Dr.Wise智能骨龄评测系统,分别按照Tanner Whitehouse(TW)3法中的TW3-RUS(桡骨、尺骨、掌指短骨)和TW3-Carpal(腕骨)计分法、中华05法中的TW3-Chinese RUS(TW3-C RUS)和TW3-Chinese Carpal(TW3-C Carpal)计分法、Greulich-Pyle(G-P)图谱法5种方法测量骨龄。根据性别和年龄进行分层分析,采用Wilcoxon符号秩和检验比较各标准评价所得骨龄与实际年龄之间的差异。结果根据性别分层分析,除男性儿童G-P图谱法所得骨龄与实际年龄间差异无统计学意义(Z=-0.694,P=0.488)外,其余男女儿童中各标准测量的骨龄均大于实际年龄,差异均有统计学意义(P<0.05)。根据性别和年龄进行分层分析,除4~6岁男性儿童G-P图谱法、11~12岁女性儿童TW3-Carpal计分法和TW3-C RUS计分法测得骨龄平均水平较实际年龄值偏小外,其余大多数组段各标准测得骨龄均大于儿童实际年龄。结论TW3法、中华05法和G-P图谱法评价北京农村区域儿童骨龄均存在不同程度的偏差,建立适合中国当代儿童的骨龄评价新标准势在必行。

Objective To evaluate the applicability of bone age(BA)assessment methods and to investigate the difference between BA and chronological age(CA)based on the data of children in rural areas of Beijing.Methods A total of 412 healthy children(226 boys,186 girls)with the age 8.6(6.8,10.3)years old were included in this study.The data of the prospective study were from a subgroup of the project"National Nutrition and Health Systematic Survey for 0-18 Years Old Children in China",which included children with age of 3-12 years old in Beijing rural areas.The non-dominant hand-wrist radiographs of all participants were obtained in April 2021.The Dr.Wise BA detection and analysis system was used to assess the BA according to the Tanner Whitehouse 3(TW3)radius-ulna-short bone score(TW3-RUS),TW3 carpal bone score(TW3-Carpal),China-05 TW3-Chinese RUS(TW3-C RUS),China-05 TW3-Chinese carpal(TW3-C Carpal),and Greulich-Pyle(G-P)standards.The cases were stratified by the sex and different CA in the statistical analysis.The estimated BA obtained using different methods were compared with the CA using Wilcoxon signed ranks test.Results The sex-stratified results showed that no significant difference was found between the estimated BA using G-P standards and CA in boys(Z=-0.694,P=0.488),while all the other estimated BA results were statistically significantly higher than CA(P<0.05).Stratified by both sex and CA,the estimated BA using G-P standards in 4-6 years old boy groups,as well as the estimated BA using TW3-Carpal and TW3-C Carpal standards in 11-12 years old girl groups were lower than CA,while in the other groups,the estimated BA were higher than CA.Conclusions There were varying degrees of deviations in the BA estimations using TW3,China 05,and G-P methods for children in rural areas of Beijing.It is imperative to establish a new standard for the BA evaluation of the contemporary Chinese children.