Ballerini María Gabriela, Gaido Virginia, Rodríguez María Eugenia, Chiesa Ana, Ropelato María Gabriela
Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE)-CONICET-FEI-División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Gallo 1330, C1425EFD Buenos Aires, Argentina.
Dis Markers. 2017;2017:9238304. doi: 10.1155/2017/9238304. Epub 2017 May 16.
Androstenedione (A4) is an adrenal and gonadal steroid biomarker, useful in the assessment of children in whom steroidogenic disorders are suspected. The first key step in the evaluation of a diagnostic test resides on confident reference intervals (RI). The lack of updated A4-RI with current methods in pediatrics may mislead A4 results and limit its diagnosis accuracy.
To provide A4 reference ranges in healthy children.
Prospective, descriptive study. 283 children aged 4 days to 18 years were included. In children < 1 yr, A4 was measured directly in serum (NE-A4) and postorganic solvent extraction (E-A4) for the assessment of interfering steroids. The influence of chronological age (CA), gender, and Tanner stage (T) were investigated.
In the neonatal period, E-A4 was significantly lower than NE-A4; boys had higher NE-A4; sexual dimorphism disappeared after extraction procedure. In children older than 4 months, A4 concentration remained low until the age of 5 years. Thereafter, A4 increased significantly in association with CA and T ( = 0.65; < 0.001), obtaining the highest concentrations in children within pubertal ages without sexual dimorphism.
We recommend to perform solvent extraction in neonates and to take into account age and sexual development to properly interpret A4 results in childhood.
雄烯二酮（A4）是一种肾上腺和性腺类固醇生物标志物，有助于评估疑似患有类固醇生成障碍的儿童。评估诊断测试的第一个关键步骤在于确定可靠的参考区间（RI）。儿科目前缺乏采用当前方法的更新的A4-RI可能会误导A4检测结果并限制其诊断准确性。
提供健康儿童的A4参考范围。
前瞻性描述性研究。纳入283名年龄在4天至18岁的儿童。对于1岁以下儿童，直接测量血清中的A4（NE-A4）以及有机溶剂萃取后的A4（E-A4），以评估干扰类固醇。研究了实足年龄（CA）、性别和 Tanner 分期（T）的影响。
在新生儿期，E-A4显著低于NE-A4；男孩的NE-A4较高；萃取后性二态性消失。在4个月以上的儿童中，A4浓度在5岁之前一直较低。此后，A4随着CA和T显著增加（= 0.65；< 0.001），在青春期儿童中达到最高浓度，且无性别差异。
我们建议对新生儿进行溶剂萃取，并在解释儿童期A4结果时考虑年龄和性发育情况。
