佛山地区矮小症患儿病因分析及建立矮小症快速诊断模型的研究

Etiological analysis of children with dwarfism in Foshan area and study on establishing a rapid diagnostic model for dwarfism

目的探讨佛山地区矮小症患儿病因及建立矮小症快速诊断模型。方法选取2021年2月至2023年2月来该院儿科门诊首次就诊的150例矮小症患儿为试验组,选取同期在该院进行健康体检的健康儿童150例作为对照组。比较两组研究对象的基本资料以及胰岛素样生长因子1(IGF-1)、胰岛素样生长因子结合蛋白3(IGFBP-3)、碱性磷酸酶(ALP)、25-羟维生素D[25(OH)D]水平。采用多因素Logistic逐步回归模型分析矮小症的影响因素,建立诊断模型。绘制受试者工作特征(ROC)曲线,评估诊断模型对佛山地区矮小症的诊断效能。结果纳入的150例矮小症患儿发病原因一共有12种,其中生长激素缺乏、特发性身材矮小是矮小症发病的主要原因,分别占58.0%(87/150)和27.3%(41/150)。试验组体质量指数、父亲身高、母亲身高、出生体质量均低于对照组(P<0.05),营养不良发生率高于对照组(P<0.05)。试验组IGF-1、IGFBP-3、ALP、25(OH)D水平均低于对照组,差异有统计学意义(P<0.05)。多因素Logistic逐步回归分析结果显示,体质量指数低、父亲身高矮以及IGF-1、IGFBP-3、ALP、25(OH)D水平降低均是矮小症发生的独立危险因素(P<0.05)。根据分析结果构建诊断模型:LN[P/(1-P)]=0.419×X_(体质量指数)+0.537×X_(父亲身高)+0.269×X_(IGF-1)+0.833×X_(IGFBP-3)+0.741×X_(ALP)+0.582×X_(25(OH)D)-2.317。ROC曲线分析结果显示,构建的诊断模型对矮小症具有一定的诊断效能(AUC=0.720,95%CI:0.635~0.804,P<0.001)。结论生长激素缺乏、特发性身材矮小是矮小症发病的主要原因,基于生长激素-类胰岛素生长因子轴拟合的诊断模型对矮小症具有明显的诊断价值。

Objective To explore the etiology of children with dwarfism in Foshan area,and to establish the rapid diagnostic model of dwarfism.Methods A total of 150 children with dwarfism first visiting the pediatric outpatient department of this hospital from February 2021 to February 2023 were selected as the experimental group,and 150 healthy children undergoing physical examination in this hospital during the same period were selected as the control group.The basic data and levels of insulin like growth factor 1(IGF-1),insulin like growth factor binding protein 3(IGFBP-3),alkaline phosphatase(ALP) and 25-hydroxyvitamin D[25(OH)D] were compared between the two groups.The multivariate Logistic stepwise regression model was used to analyze the influencing factors of dwarfism and the diagnostic model was established.The receiver operating characteristic(ROC) curve was drawn to evaluate the diagnostic efficiency of the diagnostic model for dwarfism in Foshan area.Results Among the included 150 children with dwarfism,there were 12 causes,in which the growth hormone deficiency and idiopathic short stature were the main causes of dwarfism,accounting for 58.0%(87/150) and 27.3%(41/150),respectively.The body mass index,father′s height,mother′s height and delivery weight of the experimental group were lower than those of the control group(P<0.05),and the incidence rate of malnutrition was higher than that of the control group(P<0.05).The levels of IGF-1,IGFBP-3,ALP and 25(OH) D in the experimental group were lower than those in the control group(P<0.05).The multivariate Logistic stepwise regression analysis showed that low body mass index,father′s height,IGF-1,IGFBP-3,ALP and 25(OH) D levels decrease were the independent risk factors for dwarfism(P<0.05).The diagnostic model constructed based on the analysis results was:LN[P/(1-P)]=0.419 ×X_(body mass index)+0.537×X_(father′s height)+0.269×X_(IGF-1)+0.833 ×X_(IGFBP-3)+0.741×X_(ALP)+0.582×X_(25(OH)D)-2.317.The results of ROC curve analysis showed that the constructed diagnostic model had a certain diagnostic efficiency for dwarfism(AUC=0.720,95%CI:0.635-0.804,P<0.001).Conclusion The growth hormone deficiency and idiopathic short stature are the main causes of dwarfism.The diagnostic model based on GH-IGFs axis fitting has significant diagnostic value for dwarfism.