目的:身高(HA)和骨龄(BA)延迟在身材矮小的患者中是众所周知的。因此,根据实际年龄(CA)评估垂体发育不全可能会导致垂体发育不全的过度诊断。我们旨在探讨基于CA的PH和PV的诊断和预后价值。HA,或BA在GHD患者中。
方法:57例重度患者,40例部分GHD患者和39例ISS患者被分配到本研究中。为了定义垂体发育不全的最准确诊断,基于CA评估PH和PV,BA和HA。检查每种方法与临床特征的关系。
结果:与GH缺乏患者相比,ISS患者的平均PV明显更大。PV与包括身高SDS在内的临床特征更相关,刺激GH浓度,IGF-1和IGFBP-3SDS,rGH治疗前后的身高速度。我们发现基于BA的PV可以区分GHD和ISS(灵敏度:17%,特异性:98%,阳性预测值:94%,阴性预测值:39%),与基于PH或PV的其他方法相比,CA和HA。3%的ISS患者,根据PV-BA,17%的GHD患者患有垂体发育不全。
结论:基于BA的PV,对定义垂体发育不全具有最准确的诊断价值。但是应该记住,这种方法仍然可能会误诊患者。PV也是rGH反应的重要预测因子。
OBJECTIVE: Height age (HA) and bone age (BA) delay is well known in the patients with short stature. Therefore assessing pituitary hypoplasia based on chronological age (CA) might cause overdiagnosis of pituitary hypoplasia. We aimed to investigate the diagnostic and prognostic value of the PH and PV based on CA, HA, or BA in the patients with GHD.
METHODS: Fifty-seven patients with severe and 40 patients with partial GHD and 39 patients with ISS assigned to the study. For defining the most accurate diagnosis of pituitary hypoplasia, PH and PV were evaluated based on CA, BA and HA. The relationship of each method with clinical features was examined.
RESULTS: The mean PV was significantly larger in patients with ISS compared to the GH-deficient patients. PV was more correlated with clinical features including height SDS, stimulated GH concentration, IGF-1 and IGFBP-3 SDS, height velocity before and after rGH therapy. We found BA-based PV could discriminate GHD from ISS (Sensitivity: 17%, specificity: 98%, positive predictive value: 94%, negative predictive value: 39%), compared to the other methods based on PH or PV respect to CA and HA. 3% of patients with ISS, 17% of patients with GHD had pituitary hypoplasia based on PV-BA.
CONCLUSIONS: PV based on BA, has the most accurate diagnostic value for defining pituitary hypoplasia. But it should be kept in mind that there might be still misdiagnosed patients by this method. PV is also a significant predictor for the rGH response.