运动激发试验联合左旋多巴激发试验筛查生长激素缺乏症的价值  

Application of exercise stimulation test combined with levodopa challenge test in screening growth hormone deficiency

作　　者：李鑫 李春青 王振竞 刘欣 吕娜 王少婷 杨文涛 王淑萍 LI Xin;LI Chunqing;WANG Zhenjing;LIU Xin;LYU Na;WANG Shaoting;YANG Wentao;WANG Shuping(Department of Endocrinology,the People's Hospital of Dongying,Dongying,Shandong 257000,China;Department of Emergency,the People's Hospital of DongyingDongying,Shandong 257000,China)

机构地区：[1]东营市人民医院内分泌科,山东东营257000 [2]东营市人民医院急诊科,山东东营257000

出　　处：《中华实用诊断与治疗杂志》2024年第7期726-730,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：山东省医药卫生科技发展计划项目(202103060606);山东省老年医学会科技攻关项目(LKJGG2021Z024)。

摘　　要：目的 探讨运动激发试验联合左旋多巴激发试验筛查生长激素缺乏症(GHD)的价值,构建预测GHD的列线图模型。方法 2020年12月—2023年12月东营市人民医院行GHD筛查的矮小症患儿67例,采用化学发光法测定运动激发试验前后及口服左旋多巴30、60、90、120 min时血清生长激素(GH)水平,各时间点血清GH水平均<10μg/L者行胰岛素激发试验。根据激发试验结果将67例患儿分为GHD组39例和非GHD组28例,比较2组性别、年龄、体质量指数、身高标准差积分、坐高、骨龄、血常规、电解质、血脂、肝功能、肾功能、甲状腺功能、心肌酶、空腹血糖、糖化血红蛋白、胰岛素生长因子1水平及运动激发试验后各时间点血清GH水平。绘制ROC曲线,评估运动后即刻联合口服左旋多巴后各时间点血清GH水平筛查GHD的效能。选择筛查GHD效能较好的(AUC≥0.8)时间点的血清GH构建预测GHD的列线图模型,采用ROC曲线验证列线图模型预测GHD的效能。结果 (1)2组性别、年龄、体质量指数、身高标准差积分、坐高、骨龄、血常规、电解质、血脂、肝功能、肾功能、甲状腺功能、心肌酶、空腹血糖、糖化血红蛋白、胰岛素生长因子1水平比较差异均无统计学意义(P>0.05)。(2)GHD组运动激发试验前血清GH水平[0.578(0.186,1.689)μg/L]与非GHD组[0.729(0.277,1.950)μg/L]比较差异无统计学意义(P>0.05),运动后即刻及口服左旋多巴30、60、90、120 min时血清GH[2.830(1.235, 4.936)、1.641(0.511, 2.890)、2.160(0.606, 3.680)、1.620(0.650, 3.067)、1.350(0.520, 2.796)μg/L]水平均低于非GHD组[10.030(1.450, 14.630)、13.290(1.325, 10.900)、6.673(1.838, 10.495)、13.600(1.272, 6.615)、2.855(1.045, 5.060)μg/L](P<0.05)。(3)运动后即刻联合口服左旋多巴30、60、90、120 min时血清GH水平筛查GHD的AUC分别为0.758(95%CI:0.648~0.910,P<0.001)、0.816(95%CI:0.704~0.927,P=0.005)、0.784(95%CI:0.667~0.900,P<0.001),0.837(95%CI:0.585~0Objective To investigate the value of exercise stimulation test(EST)combined with levodopa challenge test(LCT)to the screening of growth hormone deficiency (GHD),and to establish a GHD predictive nomogram model.Methods Sixty-sevenchildren with short stature underwent GHD screening in the People’s Hospital of Dongying from December,2020to December,2023.The serum growth hormone(GH)level was detected before and immediately after EST as well as 30,60,90and 120 min after LCT by chemiluminescence method.Insulin stimulation test was performed in patients with serum GH level<10μg/L at all time points.According to the results of three tests,67children were divided into GHD group (n=39)and non-GHD group (n=28).The gender,age,body mass index,standard deviation score of height,sitting height,bone age,blood routine examination results,electrolyte,lipid,liver function,kidney function,thyroid function,myocardial enzyme,fasting plasma glucose,glycosylated hemoglobin,insulin growth factor 1,and serum GH level immediately after EST and at each time point were compared between two groups.ROC curve was plotted to evaluate the diagnostic efficiencies of serum GH level immediately after EST combined with GH level at each time point after LCT on diagnosing GHD.The serum GH level with good diagnostic efficiency of GHD (AUC≥0.8)was selected to construct a nomogram model for predicting GHD,and ROC curve was used to verify the predictive efficiency of nomogram model on GHD.Results(1)There were no significant differences in the gender,age,body mass index,standard deviation score of height,sitting height,bone age,blood routine,electrolyte,lipid,liver function,kidney function,thyroid function,myocardial enzyme,fasting plasma glucose,glycosylated hemoglobin,and insulin growth factor 1level between two groups(P>0.05).(2)There was no significant difference in serum GH level between GHD group[0.578(0.186,1.689)μg/L]and non-GHD group[0.729(0.277,1.950)μg/L]before EST(P>0.05).The serum GH level immediately after EST and 30,60,90and 120min af

关 键 词：矮小症 生长激素 运动激发试验 左旋多巴激发试验 

分 类 号：R725.8[医药卫生—儿科]