基于限制性立方样条探索儿童青少年的骨密度与骨龄发育的关系

目的 通过回顾性分析重庆地区3 776例儿童、青少年骨密度与骨龄发育的关系，为重庆地区的儿童、青少年生长发育评估提供理论依据。方法 回顾性分析3 776例2015年至2019年间在重庆高康健康管理咨询有限公司进行咨询的儿童、青少年的左腕骨X线骨龄片、骨密度、身高、体重。应用Logistic向前逐步回归模型和限制性立方样条分层分析儿童、青少年骨密度与骨龄发育的关系。 结果 本研究中的儿童、青少年在各年龄段均出现骨龄发育提前，其中四个年龄段的男性和女性的骨龄年龄差差异有统计学意义（P<0.05）。Logistic回归分析发现性别、骨密度同龄比、生活年龄为骨龄发育的独立影响因素。在性别、年龄和BMI分层的各亚组中，骨龄发育提前的概率在骨密度较低段有少量上升然后下降，在骨密度较高段呈上升趋势，在体格消瘦和正常组中最明显；各年龄段的骨龄发育提前趋势相当；随着BMI的增加，超龄发育概率逐渐向0.8~1.0区间靠近。结论 重庆地区儿童、青少年普遍存在骨龄发育提前的现象，这种现象可能与性别、骨密度、肥胖等因素有关。

Exploration of the relationship between bone mineral density and bone age development in children and adolescents based on restricted cubic splines

Objective To provide a theoretical basis for the growth and development assessment of children and adolescents in Chongqing by retrospectively analyzing the relationship between bone mineral density and bone age development in 3776 children and adolescents in Chongqing area. Methods The left wrist bone X-ray skeletal age radiographs, bone mineral density, height, and weight of 3776 children and adolescents who had consultations at Chongqing Gaokang Health Management Consulting Co. between 2015 and 2019 were retrospectively analyzed. Logistic stepwise regression model Restricted cubic splines were used to analyze the relationship between bone mineral density and bone age development. Results In this study, the children and adolescents showed advanced bone age development at all ages. Among those, there was a statistical difference in bone age between men and women only in four age divisions (P<0.05). Logistic regression analysis results showed that gender, bone mineral density, age of life were independent influential factors for the bone age development. In subgroups stratified by sex, age, and BMI, the probability of premature bone age development had a small increase and then decrease in the lower BMD bands and an increasing trend in the higher BMD bands, and it was most pronounced in the physically lean group and normal group. The trend of early bone age development was comparable between each age group. As BMI increased, the probability of premature bone age development gradually approached the 0.8 to 1.0 range. Conclusion Premature bone age development in children and adolescents is a common phenomenon in Chongqing area. It might be related to factors of gender, bone mineral density, and obesity.