胰岛素诱发低血糖试验对成人生长激素缺乏症诊断意义的探讨  

Significance of insulin tolerance test in the diagnosis of adult growth hormone deficiency

作　　者：高丽[1] 郑郁[1] 巴建明[1] 金楠[1] 杨国庆[1] 窦京涛[1] 欧阳金芝[1] 杜锦[1] 王先令[1] 郭清华[1] 谷伟军[1] 李晶[1] 潘长玉[1] 陆菊明[1] 李江源[1] 母义明[1] 

机构地区：[1]解放军总医院内分泌科,北京100853

出　　处：《中华内分泌代谢杂志》2012年第12期994-997,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨胰岛素诱发低血糖试验（ITT）对成人生长激素缺乏症（GHD）的临床诊断意义。方法回顾解放军总医院收治的82例成人GHD患者[男：女=53：29，（30．9±12．3）岁（18～65岁）]的ITT结果，选取15位健康者作为对照组[男：女=9：6，（26．7±5．6）岁（22—41岁）]，利用受试者工作特征（ROC）曲线并计算曲线下面积（AUC），以确定诊断成人GHD的GH峰值和GH增加值的切点。结果（1）ITT试验中对照组GH峰值明显高于成人GHD组（中位数分别为14μg/L、0．62μg/L，P=0．001）。诊断成人GHD的GH峰值最佳切点[化学发光免疫分析法（CLIA）]为4．935μg/L（AUC为0．993）。（2）对照组的GH增加值明显高于成人GHD组（中位数分别为13．17μg/L、0．19μg／L，P〈0．001），诊断成人GHD的GH增加值切点为4．088μg/L（AUC为0．937），敏感度、特异度分别为91．5％、93．3％。（3）GH峰值的诊断价值较GH增加值更高。（4）本研究中GH峰值的最佳切点（CLIA）4．935μg／L，与成人GHD的诊治指南中，血清GH峰值的切点5μg/L（放射免疫分析法RIA）的敏感性和特异性基本一致（分别为95．1％、100．0％）。结论成人GHD的诊治指南中，诊断成人GHD的血清GH峰值（CLIA）的切点小于5μg/L，在我国仍具有较高的诊断价值。Objective To assess the significance of insulin tolerance test （ITT） in clinical diagnosis of adult growth hormone deficiency（GHD）. Methods Eighty-two patients with an established diagnosis of adult GHD [ 53 males, 29 females, mean age （ 30.9 ± 12.3 ） years（ 18-65 years） I were reviewed retrospectively for evaluating the GH response to ITT in the General Hospital of the People＇s Liberation Army. Control data for peak GH after ITT were obtained in 15 healthy subjects [ 9 males, 6 females, mean age （26.7 ± 5.6 ） years （22-41 years）]. Receiver operating characteristic （ROC） curve analysis and the area under the curve （AUC） were used to evaluate the diagnostic cut-off point of peak GH and GH increment response to ITI＇. Results （ 1 ） Mean peak GH response to ITT was significantly higher in 15 controls compared with 82 patients （ the median 14μg/L vs 0. 62 μg/L, P = 0. 001 ）. The cut-off point of the peak GH （ chemiluminescent immunoassay, CLIA） response to ITY in adult GHD was 4. 935 μg/L （ AUC 0. 993 ）. （2） Mean GH increment was significantly higher in 15 controls compared with 82 patients （ the median 13.17 μg/L vs 0. 19 μg/L, P〈0. 001 ）. The cut-off point of the GH increment was 4. 088 μg/L（ AUC 0.937 ）, with a 91.5% sensitivity and 100% specificity. （ 3 ） The peak GH showed even higher diagnostic value than the GH increment after ITL （4）The above mentioned cut-off points （ peak GH less than 4. 935μg/L and 5 μg/L） had a coincidence with a 95.1% sensitivity and 100% specificity, respectively. Conclusion The current guidelines for the diagnosis of adult GHD based on the optimal cut-off point of the peak GH （CLIA） response to ITT less than 5μg/L turned to be of reliable diagnostic value in our country.

关 键 词：胰岛素诱发低血糖试验 切点 成人生长激素缺乏症 生长激素 

分 类 号：R725.8[医药卫生—儿科]