EFFICACY OF INSULIN-LIKE GROWTH FACTOR-I LEVELS IN PREDICTING THE RESPONSE TO PROVOCATIVE GROWTH-HORMONE TESTING
EFFICACY OF INSULIN-LIKE GROWTH FACTOR-I LEVELS IN PREDICTING THE RESPONSE TO PROVOCATIVE GROWTH-HORMONE TESTING
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DOI：
10.1203/00006450-199001000-00015
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发表时间：
1990-01-01
影响因子：
3.6
通讯作者：
ROSENFELD, RG
中科院分区：
文献类型：
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作者：
LEE, PDK;WILSON, DM;ROSENFELD, RG
生长激素（GH）充足性的临床测试是内分泌学中有争议的领域。由于内源性GH分泌的偶发性，GH缺乏症的诊断被定义为对至少两种刺激的反应未能达到正常GH水平。该测试与显著的患者发病率和成本相关。我们分析了我们的经验超过4年的时间，以确定是否临床或生化变量可以用来预测一个特定的生长激素检测程序的结果。在分析的180例病例中（67%为男性，平均年龄8.89 ±. 4.39年龄范围为新生儿-16岁），8例GH检测结果不完整。其余172例中，19例为GH缺乏（GH水平< 7 ng/mL）。年轻的年龄，更高的体重指数和更大程度的骨龄延迟生长激素缺乏人群的特点，但是，这些变量都没有单独的诊断效用。81%的GH缺乏儿童和47%的GH充足儿童的血清IGF-1水平低于正常范围;并且是提供合理组间差异的唯一单一变量。判别分析导致一个新的变量的发展，IGF-I Z评分的基础上，年龄，骨龄延迟的程度，和体重指数，这将允许排除生长激素缺乏症，而无需挑衅性测试的58%的生长激素充足的人口，而允许诊断生长激素缺乏症的所有生长激素缺乏症的科目。我们的数据取决于IGF-I测定方法和GH缺乏症的临床定义;因此，计算的预测值不适用于所有临床人群。然而，我们的数据提供了一个新的观点，IGF-I水平和临床信息的整合，预测生长激素充足。
Clinical testing of growth hormone (GH) sufficiency is a controversial area in endocrinology. Due to the episodic nature of endogenous GH secretion, diagnosis of GH deficiency has been defined as a failure to achieve normal GH levels in response to at least two stimuli. This testing is associated with significant patient morbidity and cost. We analyzed our experience over a 4-y period to determine whether clinical or biochemical variables could be used to predict the results of a specific GH testing procedure. Of 180 cases analyzed (67% male, mean age 8.89 .+-. 4.39 y, range neonate-16 y), eight cases had incomplete GH testing results. Of the remaining 172, 19 were GH deficient (GH level < 7 ng/mL). Younger age, higher body mass index and a greater degree of bone age delay were characteristic of the GH-deficient population; however, none of these variables alone was of diagnostic utility. Serum IGF-1 level was below the normal range for 81% of the GH deficient and 47% of the GH-sufficient children; and was the only single variable that provided a reasonable between-group distinction. Discriminant analysis resulted in development of a new variable, based on IGF-I z scores, chronologic age, degree of bone age delay, and body mass index, which would have allowed exclusion of GH deficiency without provocative testing for 58% of the GH sufficient population, whereas permitting the diagnosis of GH deficiency for all GH-deficient subjects. Our data are dependent on the IGF-I assay method and the clinical definition for GH deficiency; therefore, the calculated predictive values are not applicable to all clinical populations. However, our data provide a new perspective on the integration of IGF-I levels and clinical information in predicting GH sufficiency.