中枢性性早熟患儿5种骨龄测定方法的比较研究

目的探讨CHN法、TW2法中日英3种标准、TW3法5种骨龄测定方法对中枢性性早熟（CPP）患儿的诊断价值及正常值临界点的确定。方法由两名医师采用盲法回顾性分析CPP患儿61例（病例组）,与每一个CPP患儿性别相同,年龄、身高、体质量基本一致的同期体检者61例、8岁以后出现乳房发育的女童6例（均为对照组）治疗前左手腕部X线片,用CHN法、TW2法中英日3种标准和TW3法进行骨龄判定,计算骨龄与年龄的差值,用SPSS13.0统计软件进行受试者工作特征（ROC）分析。结果 （1）两名医师骨龄测定结果的Kappa值为0.776（u=16.128,P〈0.05）;（2）5种骨龄测定方法的ROC曲线下面积分别为：CHN法0.921±0.024,95%可信区间为0.875～0.967;TW2法中国南方人标准为0.947±0.019（0.910～0.983）;TW2法日本人标准为0.937±0.023（0.892～0.982）;TW2法英国人标准为0.931±0.022（0.888～0.975）;TW3骨龄测定法为0.924±0.023（0.879～0.969）;5种方法的诊断价值差异无统计学意义（Z=0.85,P〉0.05）;（3）CHN中骨龄与年龄的差值≥1.25岁、TW2-CHN中差值≥1.25岁、TW2-JP中差值≥0.65岁、TW2中差值≥1.15岁、TW3中差值≥0.25岁,敏感度、特异度均较高。结论 5种骨龄测定方法对于中枢性性早熟患儿的诊断价值都较高;而TW2法中国人标准（TW2-CHN）的诊断价值最高。

Comparison research on five ways of skeletal age determination in children with central precocious puberty

Objective To discuss the diagnostic values of CHN method,Chinese,Japanese and English standards of TW2 method,and TW3 method in skeletal age（SA）determination in children with central precocious puberty（CPP）,then to comform the normal thresholds.Methods Patient group：61 children with complete information.Control group had 67 children：（1）61 cases were normal children,whose sex,age,height and weitht were similar to the patient group;（2）6 cases were girls whose breasts developed after 8 years old.Left hand-wrist X-ray radiographs before therapy were retrospectively blindly analyzed by two doctors and relevant SA were assessed with CHN method,Chinese,Japanese and English standards of TW2 method,and TW3 method.The differences between SA and chronological age（CA）Δ=（SA-CA）were analyzed with ROC in SPSS 13.0.Results（1）The SA results showed Kappa value was 0.776 by two doctors（u=16.128,P0.05）.（2）Area under the curve（AUC）of ROC：ACHN= 0.921±0.024（95% confident interval：0.875～0.967）,ATW2-CHN=0.947±0.019（0.910～0.983）;ATW2-JP=0.937±0.023（0.892～0.982）;ATW2-Br=0.931±0.022（0.888～0.975）;ATW3=0.924±0.023（0.879～0.969）.There were no statistic differences for the AUC of ROC among the five methods（Z=0.85,P0.05）.（3）Δ≥1.25 years in CHN,Δ≥1.25 years in TW2-CHN,Δ≥0.65 years in TW2-JP,Δ≥1.15 years in TW2 and Δ≥0.25 years in TW3 were more sensitive and specific points.Conclusions The five SA determination methods provide a higher diagnostic values in children with CPP,and TW2-CHN provide the hightest value for Chinese children.