体质量指数对青春期发育前身材矮小儿童生长激素激发试验峰值切点的分析

Analysis of Peak Tangential Point of Body Mass Index on Growth Hormone Stimulating Test in Prepubertal Short Stature Children

目的探讨生长激素激发试验中生长激素(GH)峰值切点在身材矮小肥胖儿童中的诊断意义。方法选取2021年1月至2022年6月于包头市儿童医院(包头市第四医院)儿童保健专科就诊的身材矮小儿童181例儿童作为研究对象,并按照BMI将研究儿童分为正常体重组、超重组和肥胖组。比较3组间GH、GH峰值等指标的差异,并对儿童进行随访,采用受试者工作特征曲线(ROC)分析超重/肥胖组患儿GH峰值进行身材矮小儿童的病因诊断的准确性。结果正常组、超重组、肥胖组儿童GH峰值平均水平分别为10.78 ng/mL、10.74 ng/mL和9.28 ng/mL,逐渐降低,差异有统计学意义(P<0.05),两两比较中,肥胖组GH峰值低于正常组和超重组。正常组、超重组、肥胖组儿童GH平均水平分别为1.39 ng/mL、1.36 ng/mL和1.12 ng/mL,差异无统计学意义(P>0.05)。根据ROC曲线分析结果显示,当GH峰值取临界值为8.84 ng/mL时,诊断生长激素缺乏症的灵敏度为0.878,特异度为0.833。结论GH激发试验中GH峰值对身材矮小儿童的病因诊断有重要的意义,应考虑体质量指数对GH峰值的影响。

Objective To investigate the diagnostic significance of growth hormone(GH)peak tangency in short stature obese children in growth hormone stimulation test.Methods A total of 181 short stature children were enrolled in the Children's health care Department of Baotou Children's Hospital(the Fourth Hospital of Baotou)from January 2021 to June 2022.The children were divided into obese group,overweight group and normal weight group according to BMI.The differences of GH and GH peak among the three groups were compared,and the children were followed up.Receiver operating characteristic(ROC)curve was used to analyze the accuracy of the etiology diagnosis of short stature children with GH peak in the overweight/obese group.Results The average GH peak levels in the normal group,the ultra recombinant group and the obese group were 10.78 ng/mL,10.74 ng/mL and 9.28 ng/mL,respectively,and gradually decreased,the difference was statistically significant(P<0.05).The GH peak in the obese group was lower than that in the normal group and the ultra recombinant group.The average GH levels in normal group,hyperrecombinant group and obese group were 1.39 ng/mL,1.36 ng/mL and 1.12 ng/mL,respectively,with no statistical significance.According to the ROC curve analysis results,when the critical value of GH peak was 8.84 ng/mL,the sensitivity and specificity of the diagnosis of growth hormone deficiency was 0.878 an d 0.833.Conclusion The GH peak value in GH stimulation test is of great significance in the etiology diagnosis of short stature children,and the influence of body mass index on GH peak value should be considered.