心得安运动激发试验对儿童生长激素缺乏症的诊断价值  

Diagnostic value of the propranolol-exercise provocative test for growth hormone deficiency in children

作　　者：郑方圆[1] 王雪梅[1] 王新利[1] 

机构地区：[1]北京大学第三医院儿科,北京100191

出　　处：《中国当代儿科杂志》2015年第2期180-184,共5页Chinese Journal of Contemporary Pediatrics

摘　　要：目的探讨心得安运动激发试验对儿童生长激素缺乏症（GHD）的诊断价值。方法选择在2009年1月至2013年3月期间因身材矮小症住院,同时完善胰岛素激发和心得安运动激发两项试验的儿童,共120例,记录激发试验前后静脉血GH值。将激发试验后血GH峰值〈10 ng/m L定义为激发阴性,GH峰值≥10 ng/m L定义为激发阳性。将两项激发试验后血GH峰值均〈10 ng/m L者诊断为GHD。结果 120例矮小儿童中,诊断为GHD者29例（24.2%）。胰岛素激发试验阳性率为48.3%。心得安运动激发试验阳性率为65.8%。两项激发试验的总符合率为62.5%,阳性符合率为79.3%。心得安运动激发后血GH峰值显著高于胰岛素激发试验的GH峰值。胰岛素激发试验血GH峰值多出现在试验后30~60 min,心得安运动激发试验GH峰值多出现在试验后的120 min。心得安运动激发试验未见不良反应发生。结论心得安运动激发试验与胰岛素激发试验对GH的激发结果符合率较高,且比胰岛素激发试验更易刺激GH分泌,临床可考虑同时应用胰岛素激发试验、心得安运动激发试验联合诊断GHD。Objective To assess the diagnostic value of the propranolol-exercise provocative test for growth hormone deficiency（GHD） in children. Methods This study included 120 children who received both the insulin provocative test and the propranolol-exercise provocative test due to short stature between January 2009 and March 2013. Growth hormone（GH） levels in venous blood were measured before and after the provocative test. Peak GH 〈10 ng/m L was defined as negative stimulation, while peak GH ≥10 ng/m L was defined as positive stimulation. The children whose peak GH levels were 〈10 ng/ m L after both tests were diagnosed with GHD. Results Twenty-nine（24.2%） of the 120 children with short stature were diagnosed with GHD. The positive rate in the insulin provocative test was 48.3%, versus 65.8% in the propranolol-exercise provocative test. The overall coincidence rate and positive coincidence rate of the two tests were 62.5% and 79.3%, respectively. The peak GH after the propranolol-exercise provocative test was significantly higher than that after the insulin provocative test（P〈0.01）. Peak GH occurred mostly at 30-60 minutes after the insulin provocative test, while that occurred mostly at 120 minutes after the propranololexercise provocative test. No adverse effects were observed in the propranolol-exercise provocative test. Conclusions Coincidence rates in stimulating the secretion of GH are high between the propranolol-exercise provocative test and the insulin provocative test. Compared with the insulin provocative test, the propranolol-exercise provocative test is more likely to stimulate the secretion of GH. GHD can be clinically diagnosed by the insulin provocative test combined with the propranolol-exercise provocative test.

关 键 词：心得安运动激发试验 胰岛素激发试验 生长激素缺乏症 儿童 

分 类 号：R725.8[医药卫生—儿科]