骨龄测定及成年身高预测的临床应用

骨骼测定年龄(age determination by skeleton)简称骨龄(skeletal age,SA),是指儿童青少年骨骼发育水平同骨发育标准比较而求得的发育年龄。影响骨骼发育最重要的因素是下丘脑-垂体-性腺轴系统,包括垂体、甲状腺、肾上腺皮质及性腺等内分泌腺分泌的激素对骨骼发育起调节和控制作用,其中性激素在青春期骨骼发育中起主导作用。 骨龄测定及成年身高预测的方法 一、骨龄测定 摄左手腕正位X光平片,分析骨骺的数量、大小及形状,估计其发育水平。包括计数法、图谱法、评分法和计算机辅助骨龄分析,最常用的是TW_2评分法和     

身高的预测

精确的预测小儿的成年身高对治疗小儿生长性疾病是一有用的工具。许多学者对此进行了研究。Tanner和Roche等人应用标准多元线性回归分析等方法来预测小儿的成年身高并加以评价,本文对此加以综述。     

下丘脑-垂体-性腺轴抑制程度对中枢性性早熟女童成年预测身高的影响

目的 研究促性腺激素释放激素类似物(GnRHa)治疗过程中下丘脑-垂体-性腺轴(HPGA)抑制程度与中枢性性早熟(CPP)女童成年预测身高(PAH)的关系,以指导临床个体化调节GnRHa 治疗剂量。方法 收集75 例CPP 女童的临床资料,记录GnRHa 治疗的不同时间点身高、骨龄(BA)、子宫卵巢容积及LH、FSH 峰值、E2 水平,计算各时间点PAH,分析PAH 改善(ΔPAH=PAH-靶身高)的情况及其与HPGA 抑制的关系,并采用阈值效应分析寻找ΔPAH 的最佳HPGA 抑制范围。结果 GnRHa 治疗后PAH 较治疗初期有明显改善。ΔPAH 与ΔBA 呈负相关;治疗24 月时ΔPAH 与LH 呈负相关。将子宫容积控制在2.3~3.0 mL 之间,LH 控制在0.8 IU/L 以下,FSH 控制在2.4 IU/L 以下对延缓BA 的增长及改善PAH 有利。结论 GnRHa 治疗能改善CPP 女童的PAH。选择合适的GnRHa 治疗剂量,将子宫容积、LH、FSH 控制在一定范围内,有利于延缓BA 及改善PAH。     

儿童血清骨钙素浓度与年龄,身高相关

人从出生到青春期的骨骼生长,主要由遗传、激素、营养因素等决定的。特别是发育激增的青春期,需要性激素、生长激素、胰岛素样生长因子的协同作用,它们对于骨骼细胞的分化与成熟是非常重要的。然而,要分析骨的矿化及儿童期的骨代     

两种预测遗传终身高度方法的比较

目的 比较两种预测遗传终身高度的方法在中国上海青年的正确性。方法 中国上海青年,男>20岁(n=160),女>18岁(n=160)。以中国上海青年的终身高和他们双亲的平均身高对FPH(the Final Heightfor Parental Height)和CMH(the Corrected Midparental Height)方法进行统计分析。结果 中国上海和瑞典的研究人群的身材是不同的(P<0.001)。中国上海人比相对应的瑞典人都矮。瑞典人的父母分别比中国上海人的父母高7 cm和6 cm。瑞典人的男女青年的终身高比中国上海人男女青年都高5 cm。这两组人群位于人类发展趋势的不同阶段。中国上海二代人身高男女分别增加3.5 cm和2.2 cm,而瑞典人仅增加0.7和1.0cm。FPH方法的平均剩余终身高接近于0(0.04 cm,P=0.85),而CMH方法的平均剩余终身高明显的高于期望值0(2.87 cm,P<0.00)。中国上海青年的实际终身高平均值和FPH靶身高的平均值基本一致,无显著性差异(男P=0.58,女P=0.74)。而CMH方法则实际终身高高于靶身高(男3.1 cm,女2.6 cm),并且两者有高度显著差异(P<0.001)。结论 FPH公式优于CMH方法。     

腰围/身高比与儿童血压的相关性

目的 探讨儿童腰围／身高比（WHtR）与血压的关系，评估WHtR对儿童高血压的预测价值。方法 对贵阳市2个城区3550名（8～12岁）儿童进行身高、腰围（WC）、臀围及高血压的抽样调查，分析WHtR与血压的相关性，所获资料均进行统计学处理。结果 1．贵阳市儿童WHtR有明显的年龄和性别特征，高血压组WHtR高于正常血压组，差异有统计学意义（P〈0．05）；控制年龄、性别、身高影响的偏相关分析显示，WHtR与收缩压（SBP）及舒张压（DBP）呈显著正相关（r=0．1929，0．0878P。〈0．01）。2．WHtR与WC呈显著正相关（r=0．9347P〈0．01），其与身高的相关性较WC与身高的相关性明显减弱（r=0．0494，0．3950P〈0．05，〈0．01）。结论 WHtR计算简单，与WC高度相关；受其身高影响小，可作为儿童高血压患病风险的预测指标。     

亚临床甲状腺功能减退症对患儿骨龄和身高的影响

目的 观察亚临床甲状腺功能减退症(甲减)对儿童骨龄(BA)、身高及甲状腺激素水平的影响.方法 选取30例亚临床甲减患儿为亚临床甲减组,30例体检健康儿童为健康对照组.对每位研究对象采用同一磅秤标准,测量其身高、体质量.采用Greulich-Pyle图谱法对各组儿童左手腕指关节正位片进行BA水平的评定;采用罗氏化学发光免疫分析仪E170检测各组儿童促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)水平.采用SPSS 17.0软件比较2组儿童BA、身高、TSH、FT3及FT4的差异;BA与身高、TSH、FT3及FT4间进行Pearson相关分析.结果 亚临床甲减组儿童的BA[(8.17±2.29)岁]、身高[(131.47±13.41) cm]水平均落后于健康对照组[(10.08±2.75)岁、(141.05±15.12) cm](t=2.92、2.60,Pa<0.05);TSH水平[(5.93±1.77) mIU·L-1]显著高于健康对照组[(2.66±1.28) mIU·L-1](t=8.17,P<0.001).亚临床甲减组儿童的BA与身高呈显著正相关(r=0.940,P<0.01);BA与TSH呈显著负相关(r=-0.450,P<0.05).亚临床甲减组FT3[(5.43±1.37) pmol·L-1]、FT4[(17.29±2.03) pmol·L-1]与健康对照组[(5.83±1.11) pmol·L-1、(17.22±1.96) pmol·L-1 ]比较差异均无统计学意义(t=1.24、0.14,Pa>0.05).结论 儿童亚临床甲减可引起BA、身高的落后,需要用药物进行干预治疗.     

中国儿童身高与体重的生长模式及简单数学模型的建立

目的 探讨中国儿童身高、体重生长规律及反映规律的简单数学模型.方法 采用"2005年九市7岁以下儿童体格发育调查"及"2005年中国学生体质与健康调研"所获得的0～18岁儿童的身高、体重数据.0～6岁身高和体重曲线采用LMS法拟合,6～18岁数据采用三次样条函数平滑修匀和修正LMS法转换.生长速度根据生长曲线修匀后获得的数值计算产生.1～10岁儿童身高和体重的简单线性模型采用修匀后生长数据建立.结果 (1)我国儿童出生身长约50 cm,3、6、12、24月龄时约61、67、76、88 cm.2～10岁身高增长较为稳定,平均每年增长约6～7 cm.约3岁半和12岁时的身高分别达到出生时2倍和3倍.2～10岁估算公式:身高(cm)=年龄(岁)×6.5+76.(2)出生体重约3.3 kg.出生后第一个3个月生长速度最快,平均每月体重增加约1.0～1.1 kg;第二个3个月减慢一半,约0.5～0.6 kg,出生后第一年的后6个月又减慢一半,约0.25～0.30 kg.约3、12、24月龄时体重达到出生时的2、3、4倍.1～6岁、7～10岁体重基本呈匀速增加,平均每年分别增长2 kg和3 kg左右.1～6岁估算公式:体重(kg)=年龄(岁)×2+8,7～10岁:体重(kg)=年龄(岁)×3+2.结论 针对临床实践的需要,总结不同年龄阶段身高、体重的增长规律,提供了0～18岁儿童身高和体重的生长速度参考值,同时对1～10岁儿童身高和体重估算公式进行修订.     

基于初潮时骨龄预测女童初潮后身高剩余生长潜力的横断面调查

背景 初潮是女童进入青春发育后期的重要标志,也是身高干预的最后一个机会窗口期,且初潮受多种因素影响、个体差异很大。正确认识和掌握女童初潮后的生长规律和特点,可为临床实践中不同初潮年龄女童的终身高评估和干预决策的制定提供参考依据。目的 通过分析女童初潮时年龄、骨龄和体格发育特征,探讨初潮后预测终身高(PAH)的临床评估方法。设计 横断面调查。方法 回顾性收集2008至2018年于首都儿科研究所附属儿童医院(我院)生长发育门诊就诊、有女童月经初潮时间、体格测量数据、骨龄X片的病例。排除初潮时间与就诊时间间隔≥3个月的病例、病历诊断中有明确的影响儿童生长发育的疾病、病历诊断中有明确病因引起的继发性中枢性性早熟或外周性性早熟和既往使用过生长激素或促性腺激素释放激素抑制剂药物的病例。按事先定义的方法计算实际年龄、骨龄、身高的标准差分值(HtSDS)、PAH和预测生长潜力、骨龄HtSDS(HtSDS_BA)和女童遗传身高,3名儿童保健科医生从纸质或电子病历中按照纳入和排除标准筛选病历、提取数据和判断,单人录入至Epidata数据库。以初潮年龄每1岁为段分组,以初潮时骨龄每0.5岁为段分组。主要结局指标 初潮骨龄、PAH和预测生长潜力。结果 ① 694例女童的初潮年龄8.5~13.2(10.7±1.1)岁,初潮时骨龄12.4~12.8(12.4±0.6)岁。②初潮年龄越小的女童,骨龄提前越多,HtSDS也越高。例如,8~岁组骨龄提前(3.8±0.5)岁,HtSDS为2.6±1.3;13~岁组骨龄落后(0.7±0.7)岁,HtSDS为-1.05±0.59。骨龄校正后不同初潮年龄组的平均HtSDS_BA为-1.17~-0.68,组间差异较小。③初潮后的预测生长潜力为(7.3±2.6)cm,生长潜力仅与初潮时的骨龄高度负相关(r=-0.960,P<0.001),骨龄从11.0~岁组到13.0~岁组,平均生长潜力从12.7 cm降至4.0 cm(F=1 194.393,P<0.001)。④本研究获得PAH计算公式[0.868×身高(cm)-3.754×骨龄(岁)+73.677],拟合优度R²=0.992,据此计算预期达到不同终身高的女童初潮时身高应达到的临界值。例如,女童初潮时骨龄为12岁,PAH达到150 cm则初潮时身高应＞139.8 cm,PAH达到160 cm初潮时身高应＞151.3 cm。结论 女童初潮时骨龄相对稳定,骨龄是反映身体成熟度和预测月经来潮的可靠指标,也是预测初潮后生长潜力的关键指标。     

Increased height in diabetes mellitus corresponds to the predicted and the adult height

This study was conducted to analyse the effect of childhood-onset diabetes mellitus on adult height. The height at time of diagnosis of 35 children with insulin-dependent diabetes mellitus (IDDM) was compared with growth reference data. Predictions of the adult height were made at the time of diagnosis using the target height and the Tanner-Whitehouse II method. The adult height was compared with both the predicted values and the height of healthy adults. The height at time of diagnosis of the prepubertal children was increased compared with growth reference data, in contrast to pubertal children who had normal heights. Only the prepubertal boys were taller at time of diagnosis. The adult height of the prepubertal patients was taller than growth reference data. The mean adult height in all patients did not differ significantly from the predicted heights. In conclusion, the increased height at the start of IDDM in prepubertal children persists until adulthood.     

Prediction of adult height in healthy Japanese children

Longitudinal records from 13,707 children (6749 boys and 6958 girls), aged 6–17 years, were fitted by a smoothing cubic spline function, and the factors influencing changes in height SD score (SDS) during puberty were analysed. Height SDS at 6 years correlated closely with final height SDS. However, short children at 6 years of age tended to increase their height SDS at final height, whereas tall children at the same age tended to decrease their final height SDS. For children with the same prepubertal height, the later that pubertal maturation occurred, the greater was the final height achieved. As short children entered puberty relatively late and tall children entered puberty relatively early, height SDS tended to approach 0 SD during puberty. A prediction function obtained by multiple regression analysis using height SDS at 6 years, the percentage by which the child is overweight at 6 years, age at onset of the pubertal growth spurt (PGS) and height at onset of the PGS provides a reasonable model for the prediction of final height SDS without the need to estimate bone age.     

A comparison of target height estimated and final height attained between Swedish and Hong Kong Chinese children

Target height, the genetic potential in stature, is commonly estimated by the corrected midparental height (CMH) method. A new model for estimating target height has recently been introduced based on a large, Swedish, population-based study. The aim of this study was to compare the validity of the two methods for estimating target height in Hong Kong Chinese children. The Hong Kong Chinese were more than 10 cm shorter than the Swedes in stature. The secular increase in height over the two generations, however, was 4.2-4.8 cm for the Hong Kong Chinese, much larger than that of the Swedes (0.7-1.0 cm). The two populations are thus at different stages in the secular trend. The new model derived from Swedish population for estimating target height was shown to be applicable to Hong Kong Chinese children; the mean of residual final height values was close to zero (-0.15 cm, p = 0.74). However, the mean of residual final height was significantly above the expected value of zero (4.5 cm, p<0.0001) when the CMH method was applied to the data, which implies an underestimation bias of 4.5 cm. Consequently, if the CMH method is used to estimate target height and evaluate growth hormone treatment responses in short children, it may inflate the treatment response by 4.5 cm. In conclusion, the recently proposed model for target height estimation offers a better alternative for estimating target height in Hong Kong Chinese children and for assessing growth-promoting treatments.     

Final height and predicted height in boys with untreated constitutional growth delay

Abstract We report on 49 boys with constitutional growth delay (CGD) who were initially seen in our clinic at a mean chronological age of 13.3 years (range, 7.3–16.4) and a bone age of 11.1 years (range, 6.0–13.5). All were below the 5th height percentile for chronological age. A positive family history with delayed growth and puberty in one or both parents could be elicited in 75%. All 49 patients were re-examined at a mean age of 22.9 years (range, 20.4–31.2). Measured final height was 171.3 cm (range, 161.2–181.7), which was slightly, but significantly lower than mean target height of 173.0 cm. Final height expressed as standard deviation score (SDS) of a male adult population standard was –1.0 (range. –2.4 to +0.5), also significantly lower than initial height SDS related to bone age (SDS_BA) of –0.5 (range, –1.6 to +1.2). If related to target height (Tanner), final height was found to correlate positively with the initial bone age deficit and the initial height SDS_BA. Observed final height was also compared with the predicted adult height by the methods of Bayley-Pinneau (BP), Tanner-Whitehouse Mark II (TW II) and Roche-Wainer-Thissen. Regression equations between all three prediction methods and final height showed an excellent correlation (P<0.0001). However, only by the BP method was predicted height very close to and no different from measured final height (pairedt-test). Despite this, final height in 16 of 49 patients (32.6%) differed by more than 5.0 cm from BP predicted height. An overwhelming majority of the patients *88.6%) expressed complete or reasonable satisfaction with their adult height.Conclusion In our sample of male patients with CGD, adult height came close to but did not quite reach mean target height. The BP prediction method offers a good compromise between simplicity and accuracy but must be used judiciously because individual discrepancies with attained final height may be large and unexplained.     

A regression method including chronological and bone age for predicting final height in Turner's syndrome, with a comparison of existing methods

A total of 235 measurement points of 57 Dutch women with Turner's syndrome (TS), including women with spontaneous menarche and oestrogen treatment, served to develop a new Turner-specific final height (FH) prediction method (PTS). Analogous to the Tanner and Whitehouse mark 2 method (TW) for normal children, smoothed regression coefficients are tabulated for PTS for height (H), chronological age (CA) and bone age (BA), both TW RUS and Greulich and Pyle (GP). Comparison between all methods on 40 measurement points of 21 Danish TS women showed small mean prediction errors (predicted minus observed FH) and corresponding standard deviation (ESD) of both PTS_RUS and PTS_GP, in particular at the "younger" ages. Comparison between existing methods on the Dutch data indicated a tendency to overpredict FH. Before the CA of 9 years the mean prediction errors of the Bayley and Pinneau and TW methods were markedly higher compared with the other methods. Overall, the simplest methods—projected height (PAH) and its modification (mPAH)—were remarkably good at most ages. Although the validity of PTS_RUS and PTS_GP remains to be tested below the age of 6 years, both gave small mean prediction errors and a high accuracy. FH prediction in TS is important in the consideration of growth-promoting therapy or in the evaluation of its effects.     

Prediction of final height in short, normal and tall children

Measurements of final height were made on more than 4000 children in the final grade of school in Gothenburg in 1992; at the same time, mid-parental heights were recorded. These data were combined with other information (sex, length of gestation, size at birth, estimated age at peak height velocity (PHV) and height measurements made before 8 years of age) and used in a multiple regression analysis to assess the strength of the linear relationship between attained final height and these other potentially predictive measures of adult height. The R² value increased from 0.16 at birth to 0.64 when the child was 8 years old. The inclusion of mid-parental height in the regression analysis contributed significantly to the explained variation in final height, especially at the earlier ages; the further addition of size at birth and age at PHV provides a small increase in the explained variation. The probability that the final height of a child will be below -2 or above +2 standard deviation scores (SDS) was assessed, based on previous SDS values for height when younger and on mid-parental height SDS. As a result of the large sample size included in the analyses, considerable confidence can be placed on the accurate prediction of final height values in the range -2.5 to +2.5 SDS.     

Onset of puberty and near adult height in short children born small for gestational age and treated with GH: Interim analysis of up to 10 years of treatment in Japan

The safety and effectiveness of long-term (10-yr) GH treatment in short Japanese children born small for gestational age (SGA) were evaluated based on interim data analysis from a clinical study, including the findings concerning the influence on the onset of puberty and subjects who achieved near adult height (NAH). Sixty-one subjects were analyzed at baseline in this study. Eleven subjects (6 boys and 5 girls) achieved NAH (mean 157.4 cm and 145.5 cm, respectively), and the Δ height SDS from the start of GH treatment was +1.6 in boys and +1.8 in girls. The median age (yr) at onset of puberty was 11.4 in boys and 9.9 in girls, comparable to healthy children. However, the mean height (cm) at onset of puberty (137.0 in boys; 125.5 in girls) was shorter than that of healthy children. Treatment-related adverse events were generally mild to moderate in severity; however, adenoidal hypertrophy was observed in two subjects as a serious adverse event. One subject had jaw malformation related to GH treatment at a dose of 0.067 mg/kg/d. No notable changes in HbA1c levels were observed, and the levels remained within the reference range. We have confirmed the safety and effectiveness of long-term GH treatment through this ongoing clinical study.     

Relationship between height, sitting height and subisehial leg length in Dutch children: presentation of normal values

A widely used method of judging body proportions is to consider the ratio of sitting height to height (SH/H) related to age. A drawback of this method is that only one derived variable is used. A pairwise consideration of the original measurements provides more information. In this study data from the cross–sectional Oosterwolde I growth study are used to present normal values for the ratio SH/H for age, as well as values for sitting height related to height and subisehial leg length. A comparison is made with other studies.