特发性中枢性性早熟女童血清骨形成标志物的变化及意义

Study on serum markers of bone formation with idiopathic central precocious puberty in girls

摘要:

目的：观察特发性中枢性性早熟（idiopathic central precocious puberty，ICPP）女童血清骨形成标志物C型利钠肽氨基末端（amino-terminal pro-C-type natriuretic peptide，NT-proCNP）、骨型碱性磷酸酶（bone alkaline phosphatase，BAP）、骨钙素（osteocalcin，OC）、胰岛素样生长因子-1（insulin-like growth factor-1，IGF-1）的变化，探讨其与ICPP的关系。方法：选取ICPP女童100例和正常对照组体检健康女童100例，ELISA测定血清骨形成指标（NT-proCNP、OC、BAP和IGF-1），采用SPSS 26.0软件进行相关统计学分析。结果：①ICPP组NT-proCNP、OC、BAP及IGF-1水平高于正常对照组（均P<0.05）；血清NT-proCNP与IGF-1水平在Tanner Ⅱ期较Ⅲ期高（P<0.05）。②ICPP女童骨龄与实际年龄差值ΔBA-CA与NT-proCNP呈负相关，与IGF-1呈正相关。③ROC曲线特征：血清NT-proCNP、OC、BAP和IGF-1对ICPP有一定的诊断价值，以IGF-1的敏感度及特异度最高。④促性腺激素释放激素类似物（GnRHa）治疗6个月后血NT-proCNP、OC、BAP和IGF-1浓度均较治疗前降低（均P<0.05），血NT-proCNP、OC和IGF-1浓度较正常对照组比较无差异，而血BAP浓度仍高于正常对照组。结论：血清NT-proCNP、OC、BAP及IGF-1水平可间接反映ICPP女童的生长发育状态，具有一定的诊断价值，可作为ICPP治疗效果的观察指标。

Abstract:

Objective：To observe the changes of serum bone formation markers such as amino-terminal pro-C-type natriuretic peptide（NT-proCNP），bone alkaline phosphatase（BAP），osteocalcin（OC） and insulin-like growth factor-1（IGF-1） in girls with idiopathic central precocious puberty（ICPP），so as to explore the relationship among them. Methods：A total of 100 ICPP girls and 100 healthy controls were collected in the study. The serum bone formation indicators（NT-proCNP，OC，BAP and IGF-1） were measured by ELISA. SPSS 26.0 was used for relevant statistical analysis. Results：①The levels of NT-proCNP，OC，BAP and IGF-1 in the ICPP group were higher than those of the normal control group（all P<0.05），and serum NT-proCNP and IGF-1 levels in Tanner Ⅱ were higher than those in the stage Ⅲ（P<0.05）. ② The difference between bone age and chronological age in girls with ICPP was negatively correlated with NT-proCNP and positively correlated with IGF-1. ③Characteristics of ROC curve showed that serum NT-proCNP，OC，BAP and IGF-1 had certain diagnostic value for ICPP，and IGF-1 had the highest sensitivity and specificity. ④After six months of treatment with GnRHa，the levels of NT-proCNP，OC，BAP and IGF-1 in ICPP were all lower than those before treatment（all P<0.05）. Compared with the normal control group，the concentrations of NT-proCNP，OC and IGF-1 in blood were not statistically different，while the concentration of BAP in blood was still higher in ICPP after six months of treatment with GnRHa. Conclusion：Serum levels of NT-proCNP，OC，BAP and IGF-1 can indirectly reflect the growth and development of girls with ICPP，so it is partly valuable for early diagnosis of ICPP. We suggest that these indexes may be used to observe the therapeutic effect of ICPP.