Paediatric Endocrine Unit, Department of Paediatrics, Stellenbosch University, Tygerberg Children's Hospital, Cape Town, South Africa.
BMJ Open. 2013 Aug 1;3(8):e002935. doi: 10.1136/bmjopen-2013-002935.
To determine which parameter is the most useful screening test for hypothalamic-pituitary-adrenal suppression in asthmatic children.
Cross-sectional study.
Paediatric allergy clinics in Cape Town, South Africa.
143 asthmatic children of mostly mixed ancestry, aged 5-12 years.
Primary outcome measures included Spearman correlation coefficients (r) calculated between the postmetyrapone (PMTP) serum adrenocorticotropic hormone (ACTH), 11-deoxycortisol (11DOC), 11DOC+ cortisol (C) and height, weight, height velocity, weight velocity, change in systolic blood pressure from supine to standing, early morning urinary free cortisol (UFC), morning C, ACTH and dehydroepiandrosterone sulfate (DHEAS). Secondary outcome measures were the receiver operating characteristics (ROC) curve and the diagnostic statistics for the most promising test.
All screening variables were weakly correlated with the three PMTP outcomes. Only DHEAS and UFC (nmol/m(2)) were statistically significant-DHEAS for PMTP ACTH and 11DOC (r=0.20, p=0.025 and r=0.21, p=0.017); UFC (nmol/m(2)) for PMTP 11DOC and 11DOC+C (r=0.19, p=0.033 and r=0.20, p=0.022). The area under ROC curve for DHEAS in the 5-year to 9-year age group was 0.69 (95% CI 0.47 to 0.92). At DHEAS cut-off of 0.2 µmol/L: sensitivity=0.88 (CI 0.47 to 1.00), specificity=0.61 (CI 0.42 to 0.78), positive predictive value=0.37 (CI 0.16 to 0.62), negative predictive value=0.95 (CI 0.75 to 1.00), accuracy=0.67 (CI 0.50 to 0.81), positive likelihood ratio=2.26 (CI 1.35 to 3.78), negative likelihood ratio=0.20 (CI 0.03 to 1.30).
No parameter is useful as a universal screening test. DHEAS may be suitable to exclude HPAS before adrenarche. Further research is needed to confirm these findings and identify factors, for example, genetic that may predict or protect against HPAS.
确定哪种参数是哮喘儿童下丘脑-垂体-肾上腺抑制的最有用的筛选试验。
横断面研究。
南非开普敦的儿科过敏诊所。
143 名哮喘儿童，主要为混合血统，年龄 5-12 岁。
主要结果测量指标包括计算后美替拉酮（PMTP）血清促肾上腺皮质激素（ACTH）、11-脱氧皮质醇（11DOC）、11DOC+皮质醇（C）与身高、体重、身高速度、体重速度、从仰卧位到站立位的收缩压变化、清晨尿游离皮质醇（UFC）、晨 C、ACTH 和脱氢表雄酮硫酸酯（DHEAS）之间的斯皮尔曼相关系数（r）。次要结果测量指标为最有希望的测试的受试者工作特征（ROC）曲线和诊断统计学。
所有筛选变量与三种 PMTP 结果均呈弱相关。只有 DHEAS 和 UFC（nmol/m2）具有统计学意义-DHEAS 与 PMTP ACTH 和 11DOC（r=0.20，p=0.025 和 r=0.21，p=0.017）；UFC（nmol/m2）与 PMTP 11DOC 和 11DOC+C（r=0.19，p=0.033 和 r=0.20，p=0.022）。5 至 9 岁年龄组 DHEAS 的 ROC 曲线下面积为 0.69（95%CI 0.47 至 0.92）。在 DHEAS 截断值为 0.2μmol/L 时：灵敏度=0.88（95%CI 0.47 至 1.00），特异性=0.61（95%CI 0.42 至 0.78），阳性预测值=0.37（95%CI 0.16 至 0.62），阴性预测值=0.95（95%CI 0.75 至 1.00），准确度=0.67（95%CI 0.50 至 0.81），阳性似然比=2.26（95%CI 1.35 至 3.78），阴性似然比=0.20（95%CI 0.03 至 1.30）。
没有参数可作为普遍的筛选试验。DHEAS 可能适合在肾上腺功能亢进前排除 HPAS。需要进一步研究以证实这些发现，并确定可能预测或保护 HPAS 的因素，例如遗传因素。
