海拔高度对儿童及青少年骨龄发育的影响  

Influence of high altitude on bone age development of children and adolescents

作　　者：次旦旺久[1] 土旦阿旺 杨美杰 普琼穷达 王凤丹 潘慧 金征宇[4] Cidanwangjiu;Tudan awang;YANG Meijie;Puqiongqiongda;WANG Fengdan;PAN Hui;JIN Zhengyu(Department of Radiology,Tibet Autonomous Region People's Hospital,Lhasa 850000;Department of Radiology,People's Hospital of Nima County,Nagqu 852000;Department of Radiology,People's Hospital of Nagqu,Nagqu 852000;Department of Radiology,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730,China;Department of Endocrinology,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730,China)

机构地区：[1]西藏自治区人民医院放射科,西藏拉萨850000 [2]西藏自治区那曲市尼玛县人民医院放射科,西藏那曲852000 [3]西藏自治区那曲市人民医院放射科,西藏那曲852000 [4]中国医学科学院、北京协和医学院、北京协和医院放射科,北京100730 [5]中国医学科学院、北京协和医学院、北京协和医院内分泌科,北京100730

出　　处：《基础医学与临床》2023年第4期636-640,共5页Basic and Clinical Medicine

基　　金：国家自然科学基金青年科学基金(82001900);中央高水平医院临床科研专项(2022-PUMCH-A-003);中国医学科学院医学与健康科技创新工程(2021-I2M-1-051);中国医学科学院中央级公益性科研院所基本科研业务费项目(2020-RW330-003);西藏自治区自然科学基金组团式援藏医学项目[XZ2020ZR-ZY01(Z)]。

摘　　要：目的探索海拔对儿童青少年骨骼生长发育的影响规律。方法选取3种不同海拔高度的地区进行观察:北京(北京协和医院)海拔43.5 m、拉萨(西藏自治区人民医院)海拔3650 m和那曲(那曲市人民医院和那曲市尼玛县人民医院)平均海拔4500 m以上。收集2013年9月至2021年12月正常发育或因外伤就诊儿童青少年的一般资料和左手腕X线片。由1名有10年骨龄判读经验的医生在人工智能(AI)骨龄软件辅助下依据Greulich-Pyle图谱法判读骨龄。计算不同海拔不同年龄段儿童青少年骨龄与日历年龄的差值,并进行统计学分析。结果最终纳入北京407例、拉萨456例、那曲150例共1013例左手腕X线片(男671例,女342例,北京病例均为汉族,拉萨和那曲病例均为藏族)。北京地区儿童青少年的骨龄基本符合日历年龄,拉萨及那曲地区儿童青少年的平均骨龄分别落后于日历年龄0.50岁及1.33岁,男女均如此。相对于北京汉族儿童青少年,藏族男孩、女孩大部分年龄组(7~18岁)的骨龄均随海拔升高而更滞后于日历年龄。结论高原地区藏族儿童青少年骨龄落后于日历年龄,且随着海拔增加而更加明显。Objective To explore the influence of altitude on the bone growth and development of children and adolescents.Methods From September 2013 to December 2021,children and adolescents with normal development were included from the following regions with three different altitudes:Beijing(Peking Union Medical College Hospital)at 43.5 m above sea level,Lhasa(People s Hospital of Tibet Autonomous Region)at 3650 m,and Nagqu(People s Hospital of Nagqu and People s Hospital of Nima County)over 4500 m.Their demographic information and left wrist radiographs were retrospectively analyzed.Assisted by an artificial intelligence bone age(BA)software,a radiologist with 10 years of BA experience interpreted the BA using the Greulich-Pyle method.The differences between BA and chronological age(CA)in different age groups among different altitudes were calculated and statistically analyzed.Results A total of 1013 participants(671 boys and 342 girls)consisting of 407 Han from Beijing,456 Tibetan from Lhasa and 150 Tibetan from Nagqu were included.Generally,the BA of children and adolescents in Beijing conformed to the CA,while the average BA of Tibetan children in Lhasa and Naqu lagged behind the CA by 0.50 and 1.33 years,respectively.Compared with those in Beijing,the BA of most age groups(7-18 years old)of Tibetan boys and girls lagged further behind the CA with the increase of altitude.Conclusions The BA of Tibetan children in plateau area lags behind their CA and the gap becomes larger with the increase of altitude.

关 键 词：藏族 海拔 骨龄 生长发育 人工智能 

分 类 号：R725.8[医药卫生—儿科]