心得安运动激发试验对儿童生长激素缺乏症的诊断价值

Diagnostic value of the propranolol-exercise provocative test for growth hormone deficiency in children

摘要:

目的 探讨心得安运动激发试验对儿童生长激素缺乏症(GHD)的诊断价值.方法 选择在2009年1月至2013年3月期间因身材矮小症住院,同时完善胰岛素激发和心得安运动激发两项试验的儿童,共120例,记录激发试验前后静脉血GH值.将激发试验后血GH峰值<10 ng/mL定义为激发阴性,GH峰值≥10 ng/mL定义为激发阳性.将两项激发试验后血GH峰值均<10 ng/mL者诊断为GHD.结果 120例矮小儿童中,诊断为GHD者29例(24.2%).胰岛素激发试验阳性率为48.3%.心得安运动激发试验阳性率为65.8%.两项激发试验的总符合率为62.5%,阳性符合率为79.3%.心得安运动激发后血GH峰值显著高于胰岛素激发试验的GH峰值.胰岛素激发试验血GH峰值多出现在试验后30~60 min,心得安运动激发试验GH峰值多出现在试验后的120 min.心得安运动激发试验未见不良反应发生.结论 心得安运动激发试验与胰岛素激发试验对GH的激发结果符合率较高,且比胰岛素激发试验更易刺激GH分泌,临床可考虑同时应用胰岛素激发试验、心得安运动激发试验联合诊断GHD.

Abstract:

Objective To assess the diagnostic value of the propranolol-exercise provocative test for growth hormone deficiency (GHD) in children. Methods This study included 120 children who received both the insulin provocative test and the propranolol-exercise provocative test due to short stature between January 2009 and March 2013. Growth hormone (GH) levels in venous blood were measured before and after the provocative test. Peak GH <10 ng/mL was defined as negative stimulation, while peak GH ≥10 ng/mL was defined as positive stimulation. The children whose peak GH levels were <10 ng/ mL after both tests were diagnosed with GHD. Results Twenty-nine (24.2%) of the 120 children with short stature were diagnosed with GHD. The positive rate in the insulin provocative test was 48.3%, versus 65.8% in the propranolol-exercise provocative test. The overall coincidence rate and positive coincidence rate of the two tests were 62.5% and 79.3%, respectively. The peak GH after the propranolol-exercise provocative test was significantly higher than that after the insulin provocative test (P<0.01). Peak GH occurred mostly at 30-60 minutes after the insulin provocative test, while that occurred mostly at 120 minutes after the propranolol-exercise provocative test. No adverse effects were observed in the propranolol-exercise provocative test. Conclusions Coincidence rates in stimulating the secretion of GH are high between the propranolol-exercise provocative test and the insulin provocative test. Compared with the insulin provocative test, the propranolol-exercise provocative test is more likely to stimulate the secretion of GH. GHD can be clinically diagnosed by the insulin provocative test combined with the propranolol-exercise provocative test.