骨代谢标志物在特发性中枢性性早熟女童血清中的变化及意义  

Bone metabolism markers in girls with idiopathic central precocious puberty

作　　者：吴慧平[1] 金献江[1] 罗越[1] 荣星[2] 陈其[2] 单小鸥[1] 

机构地区：[1]温州医科大学附属第二医院,育英儿童医院内分泌,遗传代谢科,325027 [2]温州医科大学附属第二医院儿童心脏中心,325027

出　　处：《浙江医学》2015年第16期1347-1349,1352,共4页Zhejiang Medical Journal

基　　金：温州市科委课题(Y20140066)

摘　　要：目的 观察骨代谢标志物1型胶原氨基端前肽（P1NP）、l型胶原羧基末端交联肽（β-CTX）、骨钙素N端中分子片段（N-MID OC）及25羟维生素D含量在特发性中枢性性早熟（ICPP）女童血清中的变化,分析其意义.方法 选择内分泌、遗传代谢科6～9（7.95±1.85）岁女童124例,其中ICPP患儿49例,乳房早发育（PT）患儿40例,健康女童35例.所有入选儿童均清晨空腹采血,采用电化学发光免疫分析法测定P1NP、β-CTX、N-MID OC及25羟维生素D的含量,并作ROC曲线分析及相关性分析.结果 （1）与PT组相比,ICPP患儿血清P1NP及N-MID OC含量的差异均有统计学意义（P＜0.05或0.01）;（2）3组β-CTX含量及25羟维生素D含量的差异均无统计学意义（均P ＞0.05）;（3）ROC曲线分析显示,ICPP女童与健康女童鉴别时,P1NP优于N-MID OC,当P1NP＞684.3ng/ml时,其诊断ICPP的预测值＞0.816;ICPP女童与PT女童鉴别时,N-MID OC优于P1NP,当N-MID OC＜ 113ng/ml时,其诊断PT的预测值＞0.709.相关性分析显示,血清P1NP与N-MID OC存在正相关关系（r=0.657,P＜0.01）.结论 ICPP女童存在血清P1NP及N-MID OC含量升高,两项指标可作为ICPP诊断及鉴别诊断的辅助指标.Objective To investigate bone metabolism markers in girls with idiopathic central precocious puberty（ICPP） and their clinical significance. Methods Forty nine pediatric patients with ICPP and 40 patients with premature thelarche（PT） admitted in the hospital from October 2012 to August 2013 were enrolled in the study and 35 healthy girls served as controls. No abnormalities of central nervous system were detected on CT or MRI scans, no adrenal or thyroid diseases were found in all study subjects. Blood samples were taken in the morning, and serum levels of procollagen type I N-terminal propeptide（P1NP）, β -C-terminaltelopeptide of type I collagen（ 15 -CTX）, N-terminal midfragment of osteocalcin（N-MID OC） and 25-hydroxyvita- min D （25-OH Vit D） were measured by ECLIA method. Statistical packages for IBM SPSS statistics version 22.0 were used for analysis, Results The serum contents of P1NP and N-MID OC in ICPP group were significantly higher than those in PT group （P〈0.05 and P〈0.01 respectively） and control group （all P〈0.01）; while there was no significant difference between PT group and control group. There were no significant differences in serum contents of 13 -CTX and 25-HO Vit D among 3 groups. ROCs analysis indicated that with cut-off value of 〉684.3ng/ml, the positive predictive value （PPV） of P1NP in diagnosis of ICPP was more than 0.816, and with the cut-off value of 〈113ng/ml the PPV of N-MID OC was more than 0.709 in diagnosis of PT. Serum P1NP was positively correlated with N-MID OC （r=0.657, P〈0.01）. Conclusion The elevations of bone metabolism markers P1NP, N-MID OC in ICPP girls can illustrate the phenomenon of accelerate bone formation in ICPP patients. Measurement of serum P1NP and N-MID OC is helpful in diagnosis and differential diagnosis of ICPP.

关 键 词：性早熟 骨代谢 儿童 

分 类 号：R725.8[医药卫生—儿科]