特发性性早熟女孩骨龄评价的诊断性试验研究  

Diagnostic Test of Assessment of Bone Age in Girls with Idiopathic Precocious Puberty

作　　者：宁刚[1] 周翔平[2] 吴康敏[3] 谢蜀祥[4] 向承发[3] 陈锡建[1] 

机构地区：[1]四川大学华西第二医院放射科,成都610041 [2]四川大学华西医院放射科 [3]四川大学华西第二医院儿科 [4]四川大学华西第二医院生殖内分泌科

出　　处：《中国循证医学杂志》2004年第11期759-765,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的　探讨骨龄测定对诊断特发性性早熟 (idiopathicprecociouspuberty)的诊断价值和实用性。方法　参照“金标准”选择特发性性早熟患儿 5 5例 ,正常对照 83例。回顾性分析初诊时第一张左手腕部X线照片 ,由专人用TW2 法盲法分期 ,骨龄结果分为RUS(RadiusUlnaandShortbones) ( 13骨 )骨龄、腕骨 ( 7骨 )骨龄和 2 0骨骨龄 3个系统 ,每个系统又分为 >P97、>P90 、>P75、>P50 和≤P50 5个工作点 ,并对该诊断性试验进行评价 ,比较TW2 法骨龄的 3个系统对性早熟患儿的诊断价值 ,并帮助选择正常临界点。结果　①敏感度和特异度都高的有 13骨骨龄的 >P90 点 (敏感度 0 836 ,特异度 0 916 ) ,7骨骨龄的 >P90 点 (敏感度0 74 6 ,特异度 0 916 )以及 2 0骨骨龄的 >P90 点 (敏感度 0 74 6 ,特异度 0 96 4 )和 >P75点 (敏感度 0 982 ,特异度 0 783) 4个工作点 ;② 3条ROC曲线的曲线下面积 (A)分别为 :13骨骨龄A13 0 939± 0 0 19[95 %CI( 0 90 2 ,0 977) ],7骨骨龄A70 899± 0 0 2 8[95 %CI( 0 84 5 ,0 95 4 ) ],2 0骨骨龄A2 0 0 95 8± 0 0 14 [95 %CI( 0 930 ,0 986 ) ]。 3条曲线下面积无统计学差异 (F =2 .0 3,P =0 .13) ;③骨骺核分期重复性为 89 2 8% ,可比性为 80 3% ,骨龄测定Kappa值?Objective To explore the accuracy and practicability of bone age assessment for the diagnosis of idiopathic precocious puberty (IPP).Methods According to the “Gold Standard”, we selected 55 girls with IPP for the study group, and 83 normal girls for the control group. We retrospectively analyzed the first left hand-wrist radiographs at the first visit. Bone ages were assessed by using a single-blind method according to the RUS (Radius Ulna and Short bones), carpale and 20 bones method (TW 2). Each had 5 decision thresholds (>97th percentile, >90th percentile, >75 th percentile, >50th percentile and ≤50th percentile). The diagnostic values from RUS, carpale and 20 bones methods assessing bone age were analyzed to identify the best decision threshold.Results ① Both sensitivity and specificity of the four decision thresholds were relatively higher, including >90th percentile of RUS (sensitivity 0.836, specificity 0.916), >90th percentile of carpale (sensitivity 0.746, specificity 0.916), >90th and >75th percentile of 20 bone (sensitivity 0.746, specificity 0.964 and sensitivity 0.982, specificity 0.783, respectively). ② Area under receiver operator characteristic curve (AUR): AUR of RUS 0.939 ± 0.019 (95%CI 0.902 to 0.977), AUR of carpale 0.899 ± 0.028 (95%CI 0.845 to 0.954), AUR of 20 bone 0.958 ± 0.014 (95%CI 0.930 to 0.986). No significant difference was found (F3=2.03,3=0.13). ③ Agreement assessment within-observer reliability was 89.28%, and 2between-observer reliability was 80.3% (Kappa 0.68, u3=6.87, 3<0.01). Conclusions ”RUS and 20 bones methods have high accuracy for the diagnosis of idiopathic precocious puberty. Considering sensitivity and specificity, we think that >90th percentile of RUS is the best decision threshold.

关 键 词：年龄测定 骨骼 特发性性早熟 诊断性试验 ROC曲线 

分 类 号：R725.8[医药卫生—儿科]