超重/肥胖儿童25(OH)D、骨龄、IGFＧ1变化及与性早熟关系的分析

Analysis of changes in 25(OH)D, bone age, and IGFＧ1 in overweight/obese children and association with central precocious puberty

摘要

目的 探究超重/肥胖儿童25羟维生素D[25(OH)D]、骨龄、胰岛素样生长因子1(IGFＧ1)变化及与性早熟(CPP)的关系。方法 选择2022年7月至2024年5月秦皇岛市妇幼保健院收治的104例超重/肥胖儿童为研究对象,根据其是否发生中枢性性早熟分为性早熟组(n＝32)与非性早熟组(n＝72).对比两组患儿25(OH)D、骨龄、IGFＧ1及其他临床指标情况;采用Pearson法分析超重/肥胖儿童25(OH)D、骨龄、IGFＧ1水平与临床指标的相关性;采用受试者工作特征(ROC)曲线分析25(OH)D、骨龄、IGFＧ1对超重/肥胖儿童中枢性性早熟的诊断价值。结果 性早熟组患儿身高、体质量指数(BMI)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、雌二醇(E₂)、促黄体生成素(LH)、男童睾酮(T)水平均高于非性早熟组,差异有统计学意义(t值介于2．366~11．348之间,P＜0．05);性早熟组25(OH)D低于非性早熟组,而骨龄与IGFＧ1高于非性早熟组,差异有统计学意义(t值介于2．698~8．268之间,P＜0．05);超重/肥胖儿童25(OH)D与TC、LDL、E₂、LH均呈负相关性(r值介于-0．681~-0．528之间,P＜0．05),而骨龄、IGFＧ1水平分别与TC、LDL、E₂、LH指标呈正相关性(r值介于0．534~0．735之间,P＜0．05);ROC曲线结果显示,当25(OH)D临界值为70．27ng/mL、骨龄为8．65岁、IGFＧ1为341．47pg/mL时,3项指标联合诊断的曲线下面积(AUC)为0．872,灵敏度为96．88％,特异度为62．50％,联合诊断价值更高。结论 超重/肥胖中枢性性早熟儿童25(OH)D下降,骨龄、IGFＧ1异常上升,3项指标有可能作为诊断超重/肥胖儿童发生中枢性性早熟的标志物.

Abstract

Objective To investigate the changes in 25-hydroxyvitamin D [25(OH)D], bone age, and insulin-like growth factor-1 (IGFＧ1) in overweight/obese children and the association with central precocious puberty (CPP). Methods A total of 104 overweight/obese children admitted to Qinhuangdao Maternal and Child Health Hospital from July 2022 to May 2024 were enrolled. Based on the presence or absence of CPP, they were divided into a CPP group (n＝32) and a non-CPP group (n＝72). The 25(OH)D, bone age, IGFＧ1 and other clinical indicators were compared between groups. Pearson method was used to analyze the correlation between 25(OH)D, bone age, IGFＧ1 and clinical indicators in overweight/obese children. Receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of 25(OH)D, bone age and IGFＧ1 on central precocious puberty in overweight/obese children. Results Children in the CPP group had significantly higher height, body mass index (BMI), total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), estradiol (E₂), luteinizing hormone (LH), and testosterone (T, in boys) levels than those in the non-CPP group (t＝2．366-11．348, P＜0．05). The CPP group also had significantly lower 25(OH)D levels, and higher bone age and IGFＧ1 levels (t＝2．698-8．268, P＜0．05). In overweight/obese children, 25(OH)D levels were negatively correlated with TC, LDL, E₂, and LH (r＝-0．681--0．528, P＜0．05), while bone age and IGFＧ1 were positively correlated with TC, LDL, E₂, and LH (r＝0．534-0．735, P＜0．05). ROC curve analysis showed that when the thresholds were 70．27ng/mL for 25(OH)D, 8．65 years for bone age, and 341．47pg/mL for IGFＧ1, the area under the curve (AUC) for the combined diagnosis was 0．872, with a sensitivity of 96．88％ and specificity of 62．50％, indicating superior diagnostic value. Conclusion Overweight/obese children with CPP exhibit decreased 25(OH)D and elevated bone age and IGFＧ1. These three markers may serve as diagnostic indicators for CPP in overweight/obese pediatric populations.

关键词

超重 / 肥胖 / 性早熟 / 儿童 / 骨龄 / 25羟维生素D / 胰岛素样生长因子1

Key words

overweight / obesity / central precocious puberty / child / bone age / 25-hydroxyvitamin D / insulin-like growth factor 1

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基金资助

河北省2023年度医学科学研究课题计划(20231936)