| 摘要: |
| 目的:构建基于血清胰岛素样生长因子-1(IGF-1)的儿童生长激素缺乏症(GHD)预测模型,并评估其在临床筛查及分层
治疗中的应用价值。方法:纳入2024 年7 月至2025 年3 月中山市小榄人民医院收治的矮小症患儿200 例,行系统病因学评估、
生长激素(GH)激发试验及血清IGF-1 检测。根据GH 峰值分为GHD 组与非GHD 组,采用logistic 回归构建多因素预测模型,
并评价其诊断效能;通过交叉验证进行内部验证。结果:GHD 组IGF-1 水平低于非GHD 组(P<0. 05),IGF-1<100 ng/ mL 为主要
危险因素(OR=3. 92,95%CI 2. 17~ 6. 67)。骨龄延迟、丙氨酸氨基转移酶( ALT)、天冬氨酸氨基转移酶( AST)、碱性磷酸酶
(ALP)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)等与GHD 存在统计学相关性。本模型曲线
下面积(AUC)为0. 93,灵敏度89. 2%,特异度85. 0%;交叉验证AUC 为0. 91,提示模型具有良好稳定性。在此基础上构建评分
分层方案,不同风险水平在临床干预策略上呈差异趋势。结论:基于IGF-1 联合多指标构建的预测模型可提高GHD 的早期识
别能力,可为分层及个体化治疗提供参考,具有一定临床应用价值。
[关键词]生长激素缺乏症;胰岛素样生长因子-1;矮小症;预测模型; |
| 关键词: 生长激素缺乏症 胰岛素样生长因子-1 矮小症 预测模型 分层治疗 重组人生长激素 骨龄延迟 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2026.05.004 |
|
| 基金项目:基金项目:广东省中山市社会公益科技研究项目,编号2024B1017。 |
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| Construction of Predictive Model for Children with Growth Hormone Deficiency Based on Insulin-LikeGrowth Factor-1 Combined with Multiple Indicators and Pharmacological Intervention Strategies |
| Lyu Zhiliang, Xiao Zhen, Li Yuanbin, Wu Weizhao |
| (Xiaolan Clinical College, Shantou University Medical College, Xiaolan
People’s Hospital of Zhongshan, Zhongshan Fifth People’s Hospital, Guangdong Zhongshan 528415, China) |
| Abstract: |
| Objective: To construct a diagnostic predictive model for children with growth hormone deficiency (GHD) based on serum
insulin-like growth factor-1 (IGF-1) and to evaluate its potential value in clinical screening and stratification treatment. Methods: A
total of 200 children with short stature admitted into Xiaolan People’s Hospital of Zhongshan from Jul. 2024 to Mar. 2025 were enrolled.
All participants underwent comprehensive etiological evaluation, growth hormone ( GH ) stimulation tests, and serum IGF-1
measurement. Patients were classified into the GHD group and non-GHD group according to GH peak levels. A multivariable prediction
model was established by using logistic regression, and its diagnostic performance was assessed. Internal validation was performed by
using cross-validation. Results: Serum IGF-1 levels were significantly lower in the GHD group than those in the non-GHD group (P<0.05).
IGF-1<100 ng/ mL was identified as a major risk factor for GHD (OR = 3. 92, 95% CI 2. 17 to 6. 67). Delayed bone age, alanine
aminotransferase (ALT), aspartate aminotransferase ( AST), alkaline phosphatase ( ALKP), free triiodothyronine ( FT3), free
thyroxine (FT4), and thyroid stimulating hormone (TSH) showed statistical correlation with GHD. The model achieved an area under
the curve (AUC) of 0. 93, with a sensitivity of 89. 2% and a specificity of 85. 0%. The cross-validation AUC was 0. 91, indicating that
the model had good stability. On this basis, a stratification scheme was constructed, and different risk levels showed a trend of
differences in clinical intervention strategies. Conclusion: The prediction model constructed based on IGF-1 combined with multiple
indicators can enhance the early identification ability of GHD, and provide reference for stratification and individualized treatment, with
certain clinical application value. |
| Key words: growth hormone deficiency insulin-like growth factor-1 short stature predictive model stratification treatment recombinant human growth hormone delayed bone age |
