生长激素缺乏儿童的酸碱平衡研究

Study for acid-base homeostasis in children with growth hormone deficiency

目的 :探讨生长激素缺乏 (GHD)和特发性矮身材 (ISS)儿童血浆实际碳酸氢盐浓度 (AB)差异 ,以及碳酸氢盐标准差评分 (SDS)在 GHD诊断中的价值。方法 :对 4 7例矮小症儿童作血气分析及电解质测定及 GH激发试验 ,根据 GH激发试验的峰值分为 GHD和 ISS两组 ,比较两组血浆 AB、碳酸氢盐 SDS、阴离子间隙 (AG)的差异。结果 :GHD儿童血浆 AB、碳酸氢盐 SDS分别为 (2 2 .6 0± 1.2 9) mmol/L、- 0 .2 7± 0 .98,明显低于 ISS组 [(2 3.80±0 .95 ) mmol/L、0 .6 4± 0 .73],P<0 .0 1;而 AG GHD组为 (11.73± 4 .5 2 ) mmol/L高于 ISS组 [(7.87± 1.70 ) mmol/L],P<0 .0 1。在碳酸氢盐 SDS≤ 1s的矮小儿童中 ,72 % (31/4 3)患儿为 GHD。结论 :GHD儿童血浆 AB、碳酸氢盐SDS明显低于 ISS儿童 ,血浆碳酸氢盐 SDS≤ 1s者应高度怀疑 GHD。

Objective: To study the difference of plasma actual bicarbonate between the children with growth hormone deficiency(GHD) and idopathatic short stature(ISS) and to value the plasma bicarbonate standard deviation scores(SDS) in diagonosis of GHD.Methods:Forty-seven short stature children were divided into two groups (GHD and ISS) according to the peak GH response to provocative test.Plasma actual bicarbonate concentrations anion gap (AG),base excess and electrolytes were measured in 47 children with short stature before GH provocative tests.Results:The mean plasma actual bicarbonate concentrations,bicarbonate SDS were (22.60±1.29)mmol/L and -0.27±0.98 respectively in GHD children,which were significantly lower than those of ISS children(P< 0.01),whereas AG was higher than that of ISS children [(11.73±4.52 vs 7.87±1.70) mmol/L],P<0.01. Seventy-two percent of patients with bicarbonate SDS≤1 s were dignosed as GHD.Conclusion:Plasma actual bicarbonate concentrations and bicarbonate SDS are lower in patients with GHD than those in patients with idopathatic short stature.Evaluation of plasma bicarbonate SDS of short stature children can predict the probability of GHD,especially when bicarbonate SDS is less than 1 s.