不同营养状况下儿童青少年骨龄发育提前或落后的风险分析

目的 分析不同营养状况下儿童青少年的骨龄发育特点，探讨超重、肥胖及消瘦与骨龄发育提前或落后的相关性。方法 运用CHN法对2012年1月至2019年2月期间在首都儿科研究所附属儿童医院就诊的4~18岁7 062例（男3 310例，女3 752例）儿童的左手腕部骨龄进行评价，利用“儿童生长发育与营养评估系统”计算体质指数Z值（BMIZ），BMIZ＜-2为消瘦组，BMIZ＞+1和BMIZ＞+2分别为超重组和肥胖组，比较不同性别和营养状况下骨龄年龄差（BAD）的差异，并对超重、肥胖儿童骨龄提前的发生风险进行分析。结果 消瘦和正常儿童平均骨龄与年龄相符，超重、肥胖儿童骨龄提前，且女童提前幅度大于男童，超重男、女童分别提前1.10岁和1.36岁（P=0.000）；肥胖男、女童分别提前1.60岁和1.78岁（P=0.000）。与正常体重相比，超重男、女童骨龄提前的风险分别增加2.358倍（95% CI：2.759~4.086）和2.483倍（95% CI：2.928~4.144）；肥胖男、女童骨龄提前的风险分别增加5.820倍（95% CI：5.066~9.181）和7.537倍（95% CI：6.319~11.534）；消瘦男、女童骨龄落后的风险分别增加1.540倍（95% CI：1.481~4.355）和3.790倍（95% CI：2.245~10.221）（P均＜0.05）。结论 超重肥胖增加骨龄提前的风险，超重男、女童骨龄提前风险接近，肥胖女童骨龄提前风险大于男童。消瘦增加骨龄落后的风险。

Risk analysis of early or late bone age development of children and adolescents with different nutritional status

Objective To analyze the characteristics of bone age development of children and adolescents with different nutritional status, and explore the association between overweight, obesity and emaciation and advanced or delayed bone age. Methods The sample included 7,062(3,310 boys and 3,752 girls) normal children and adolescents aged 4 to 18 years old from the Affiliated Children's Hospital Capital Institute of Pediatrics between January 2012 and February 2019. The bone ages were evaluated by CHN method on left hand radiographs. The body mass index z-value (BMIZ) was calculated by the child growth and nutrition assessment system. According to BMIZ, the subjects were classified into the group of emaciation (BMIZ<-2), excess weight (BMIZ>+1) and obesity(BMIZ>+2). The difference distributions between bone age and chronological age were compared among different genders and nutrition levels, and the risk of advanced bone age in overweight and obese children was analyzed. Results For overweight and obese children and adolescents, the bone age was advanced and for emaciated and normal ones, the bone age conformed to the chronological age. Overweight and obese girls were more advanced than boys (averagely, 1.10 and 1.36 years in advance in overweight boys and girls respectively P=0.000; 1.60 and 1.78 years in advance in obese boys and girls respectively P=0.000). Compared with boys and girls with normal weight, the risk of advanced bone age in overweight and obese boys and girls respectively increased by 2.358 times (95% CI:2.759-4.086) and 2.483 times (95% CI: 2.928-4.144) as well as by 5.820 times (95% CI: 5.066-9.181) and 7.537 times (95% CI: 6.319-11.534) and the risk of delayed bone age in emaciated boys and girls increased by 1.540 times (95% CI: 1.481-4.355) and 3.790 times (95% CI: 2.245-10.221) . Conclusion Excess weight and obesity increased the risk of advanced bone age in boys and girls respectively. In terms of advanced bone age, overweight boys and girls had similar risk, while obese girls had higher risk than boys. Emaciation increased the risk of delayed bone age.