吡啶斯的明与左旋多巴联合激发试验对儿童生长激素缺乏症的诊断价值  

Diagnostic value of provocative test by pyridostigmine combined with levodopa for growth hormone deficiency in children

作　　者：李燕虹[1] 杜敏联[1] 马华梅[1] 何俏华[1] 赖峰[1] 古玉芬[1] 

机构地区：[1]中山大学附属第一医院儿科,广州510080

出　　处：《中华内分泌代谢杂志》2004年第3期227-230,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的　评价吡啶斯的明 (PD)加左旋多巴 (L dopa)联合激发试验对儿童生长激素缺乏症(GHD)的诊断价值。方法　 79例生长迟缓儿童 ,根据生长学资料、临床表现及血胰岛素样生长因子Ⅰ(IGF Ⅰ )、胰岛素样生长因子结合蛋白 3 (IGFBP 3 )水平分为临床拟诊GHD组 ( 3 9例 )与非GHD (NGHD)组 ( 4 0例 ) ,全部进行PD +L dopa联合激发并随机分别另行精氨酸激发试验 (ARG ,43例 )或胰岛素耐量试验 (ITT ,3 6例 )。比较三种试验的生长激素 (GH)激发峰值及诊断敏感度、特异度、精确度 ,绘制受试者工作特性曲线 (ROC)及精确度曲线。结果　PD +L dopa联合激发试验GH峰值在NGHD组高于ARG(P <0 .0 1)或ITT(P <0 .0 5 ) ,在GHD组差异无显著性。PD +L dopa联合激发试验的准确度、特异度明显高于ARG或ITT ,敏感度与ARG或ITT相近。GH峰值取 7μg/L为正常截断值时 ,PD +L dopa联合激发试验的敏感度、特异度与准确度均最高 ,超过 80 %。结论　PD +L dopa联合激发试验对儿童GHD诊断价值优于ARG或ITT ,是一种适合儿童的有效、简便。Objective To evaluate the diagnostic value of provocative test by pyridostigmine (PD) combined with levodopa (L-dopa) for growth hormone deficiency (GHD) during childhood. Methods Seventy nine children with growth retardation were enrolled in the study and were divided into 2 groups. Group GHD comprised 39 children with the appropriate auxological characteristics and the typical phenotypic features of GHD, and their serum levels of insulin-like growth factor Ⅰ (IGF-Ⅰ) and insulin-like growth factor binding protein 3 (IGFBP 3) were 2 SDS below average concentrations. Group NGHD (non-GHD) comprised 40 children in whom GHD was excluded. All children underwent a provocative test with PD combined with L-dopa. Among them, 43 children underwent arginine (ARG) provocative test while 36 children insulin tolerance test (ITT). The mean growth hormone (GH) peak response to PD+L-dopa test was compared with that to ARG test or to ITT, and the diagnostic value including sensitivity, specificity and accuracy of each test was evaluated. Receiver operating characteristics curve (ROC) and accuracy curve for the PD+L-dopa test were made in order to determine the appropriate cut-off point of GH peak. Results In NGHD children the mean peak GH response to PD+L-dopa test was obviously higher than that to ARG test (P<0.01) or to ITT (P<0.05), while in GHD children, the mean peak GH response to PD+L-dopa test showed no difference from that to ITT or ARG test. The specificity of PD+L-dopa test (42.1%, 61.9%) was remarkably higher than that of ARG test (21.1%) or ITT (42.9%), whereas the sensitivity (95.8%, 86.7%) was similar to ARG test (95.8%) or ITT (93.3%). PD+L-dopa test had a better accuracy (72.1%, 72.2%) than that of ARG test (62.8%) or ITT (63.9%). When estimated from the test accuracy and the ROC curve, PD+L-dopa test had the best diagnostic value at the peak GH cut-off level of 7 μg/L, with specificity, sensitivity and accuracy exceeding 80%. Conclusion The diagnostic value of PD+L-dopa test is better than that of ITT or

关 键 词：吡啶斯的明 左旋多巴 联合 激发试验 儿童 生长激素缺乏症 诊断 

分 类 号：R725.8[医药卫生—儿科]