特发性矮小症患儿治疗过程中血清Ghrelin水平变化趋势及与疗效的关系

Change of serum Ghrelin levels in children with idiopathic short ststure and its relationship with efficacy during treatment

目的探讨血清饥饿激素(Ghrelin)水平对特发性矮小症(ISS)治疗效果的影响,优化ISS患儿的治疗方案。方法选择2015年11月至2023年7月于衡水市妇幼保健院进行治疗的136例ISS患儿为研究对象,根据治疗效果评估结果分为效果良好组(n=72)和效果不良组(n=64)。比较两组患儿的临床资料以及治疗前后患儿身高(Ht)、体质量(Wt)、骨龄(BA)、生长速率(GV)、Ghrelin水平变化。评估Ghrelin水平变化与治疗效果的关系。分析影响患儿治疗效果的危险因素。探讨Ghrelin与ISS患儿治疗后疗效不佳的相关性。分析Ghrelin与ISS患儿治疗后效果不良的剂量-反应关系。建立预测模型并使用十字交叉法进行模型验证评价。结果效果良好组患儿的各项生长发育情况均显著优于效果不良组的患儿,而Ghrelin水平显著低于效果不良组的患儿。联合模型显示,Ghrelin水平每升高1 nmol/L,ISS治疗效果不好的风险增加3%。调整潜在混杂因素后,发现年龄略大、日常缺乏运动、营养状况不佳、遗传身高较矮、睡眠质量不好、Ghrelin水平较高均为影响患儿治疗效果的独立危险因素。治疗后6个月内的Ghrelin水平与ISS疗效不佳风险存在独立相关性,且Ghrelin与ISS患儿治疗效果不良呈正相关。性别与ISS疗效不佳风险不存在非线性关系。预测模型区分度、准确度较好。结论血清Ghrelin在人体内以负反馈模式调节儿童的生长发育,随着血清Ghrelin的降低,能够有效降低ISS发生率,因此在ISS的治疗过程中,可将其作为临床治疗的检查标志之一,用以及时优化治疗方案。

Objective To investigate the effect of serum Ghrelin level on the treatment of idiopathic short stature,and to optimize the treatment plan for children with idiopathic short ststure(ISS).Methods A total of 136 children with idiopathic nanosomia treated in Hengshui Maternal and Child Health Hospital from November 2015 to July 2023 were selected as the study objects,and were divided into good effect group(n=72)and poor effect group(n=64)according to the evaluation results of treatment effect,and the clinical data of the two groups were compared.Compare the clinical data of two groups of children,as well as the changes in height(Ht),weight(Wt),bone age(BA),growth rate(GV),and Ghrelin levels before and after treatment.Evaluate the relationship between changes in Ghrelin levels and therapeutic effect.Analyzing the risk factors that affect the treatment effectiveness of pediatric patients.Exploring the correlation between Ghrelin and poor therapeutic efficacy in children with ISS after treatment.Analyze the dose-response relationship between Ghrelin and adverse treatment outcomes in children with ISS.Establish a predictive model and use the cross over method for model validation and evaluation.Results The growth and development of children in the good effect group were significantly better than those in the poor effect group,while the Ghrelin level was significantly lower than that in the poor effect group.The joint model showed that for every 1 nmol/L increase in Ghrelin level,the risk of poor ISS treatment efficacy increased by 3%.After adjusting for potential confounding factors,excessive age,lack of daily exercise,poor nutritional status,genetic height,poor sleep quality and high Ghrelin level were all independent risk factors affecting the therapeutic effect of children.There is an independent correlation between Ghrelin levels within 6 months after treatment and the risk of poor treatment outcomes in ISS patients,and there is a positive correlation between Ghrelin levels and poor treatment outcomes in ISS patients.There is no non-linear relationship between gender and the risk of poor ISS efficacy.The predictive model has good discrimination and accuracy.Conclusion Serum Ghrelin regulates the growth and development of children in a negative feedback mode in the human body,and the decrease of serum Ghrelin level can reduce the probability of adverse treatment effect.Therefore,in the treatment of idiopathic short ststure,it can be used as one of the examination markers of clinical treatment to optimize the treatment plan in time.