IGF-1及其相关指标对CPP患儿GnRHa治疗期间生长减速的诊断价值

Diagnostic value of IGF-1 and its related indexes for growth deceleration during GnRHa treatment in children with CPP

目的 分析胰岛素样生长因子-1(IGF-1)及其相关指标对中枢性性早熟(CPP)患儿促性腺激素释放激素类似物(GnRHa)治疗期间生长减速的诊断价值,并找出最佳参考指标及截断值以指导临床工作。方法 回顾分析53例接受GnRHa治疗的特发性CPP女童的临床资料[身高、骨龄(BA)、生长速率(CV)等],分析IGF-1及其相关指标、性激素等与生长速度的相关性,并采用受试者工作特征(ROC)曲线分析CPP患儿过度生长减速的最佳参考指标。结果 GV、GV SDS与ΔBA-IGF-1 SDS、治疗12个月时的雌二醇(E2)均呈正相关,与初诊时BA-IGF-1 SDS均呈负相关(P<0.05)。患儿以GV SDS≥0和GV SDS<0分组,ΔBA-IGF-1 SDS的ROC曲线面积最大[曲线下面积(AUC)=0.782],其最佳界值点为-1.274。结论 在GnRHa治疗期间生长减速与生长激素(GH)-IGF-1轴的变化、性类固醇缺乏有关,ΔBA-IGF-1 SDS可考虑作为CPP患儿GnRHa治疗后临床上指导联合使用重组人生长激素(rhGH)的参考指标。

Objective To analyze the diagnostic value of insulin-like growth factor-1(IGF-1)and its related indexes for growth deceleration during the treatment of gonadotropin-releasing hormone analogue(GnRHa)in children with central precocious puberty(CPP),and to find out the best reference indexes and cut-off values to guide clinical work.Methods The clinical data[height,bone age(BA),growth velocity(GV),etc.]of 53 female children with idiopathic CPP treated with GnRHa were retrospectively analyzed.The correlation between IGF-1 and its related indexes,sex hormones and growth rate was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the best reference index of excessive growth deceleration in children with CPP.Results GV and GV SDS were positively correlated withΔBA-IGF-1 SDS and estradiol(E2)at 12 months of treatment,and negatively correlated with BA-IGF-1 SDS at initial diagnosis(P<0.05).When the children were divided into GV SDS≥0 group and GV SDS<0 group,the area under the ROC curve ofΔBA-IGF-1 SDS was the largest[area under the curve(AUC)=0.782],and the optimal cut-off point was-1.274.Conclusion The growth deceleration during GnRHa treatment is related to the change of growth hormone(GH)-IGF-1 axis and the lack of sex steroids.ΔBA-IGF-1 SDS can be considered as a reference index for clinical guidance of combined use of recombinant human growth hormone(rhGH)after GnRHa treatment in children with CPP.