单纯检测血清酸不稳定亚基与联合检测 IGF-I 和 IGFBP-3 对生长激素缺乏症的诊断价值。

Diagnostic Value of Serum Acid-Labile Subunit Alone and in combination with IGF-I and IGFBP-3 in the Diagnosis of Growth Hormone Deficiency.

机构信息

Comprehensive Center for Pediatrics, Division of Pulmology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria.

Vienna Bone and Growth Centre, Vienna, Austria.

出版信息

Horm Res Paediatr. 2020;93(6):371-379. doi: 10.1159/000512336. Epub 2020 Dec 18.

DOI:10.1159/000512336

PMID:33341813

Abstract

BACKGROUND

The acid-labile subunit (ALS) is a crucial factor in the tertiary complex. IGF-I and IGFBP-3 are routinely measured during the diagnostic work-up for growth hormone deficiency (GHD). The aim of the study is to evaluate the relevance of serum ALS as an additional biomarker in the diagnosis of GHD.

METHODS

Ninety-one children undergoing standard diagnostic work-up for GHD were included in this retrospective study. Inclusion criteria were evidence-based auxological cutoffs, IGF-I and IGFBP-3 <-2 SDS at first presentation, at least 1 growth hormone (GH) stimulation test, and IGF-I, IGFBP-3, and ALS measurements on the same day. Statistical analysis was performed by ROC as well as by odds ratio calculations.

RESULTS

Forty-seven of 90 participants presented with peak GH values under the cutoff of 7 ng/mL. AUC from a model containing only IGF-I was 0.76 and 0.68 when using only ALS. A model containing IGF-I, IGFBP-3, and ALS (AUC = 0.77) did not improve the result compared to the combination of IGF-I/IGFBP-3 (0.77) or IGF-I/ALS (0.76). Furthermore, the variation in the outcome (GH peak </≥7) explained by IGF-I only amounts to 20.4%, while that explained by IGFBP-3 and ALS is only 10.6 and 7.8%, respectively. The sensitivity to diagnose GHD at respective concentrations of -2.0 SDS was 48% for IGF-I, 38% for IGFBP-3, and only 8% for ALS.

CONCLUSION

Determination of serum ALS alone or in combination with IGF-I and IGFBP-3 did not improve definition of biochemical GHD in a cohort of short children and adolescents with suspected growth disorder. However, performance of IGFBP-3 in this context was not statistically superior to ALS.

摘要

背景

酸不稳定亚基（ALS）是三级复合物的关键因素。IGF-I 和 IGFBP-3 是生长激素缺乏症（GHD）诊断过程中常规测量的指标。本研究旨在评估血清 ALS 作为 GHD 诊断的附加生物标志物的相关性。

方法

本回顾性研究纳入了 91 名接受 GHD 标准诊断评估的儿童。纳入标准为基于证据的人体测量学截断值、首次就诊时 IGF-I 和 IGFBP-3 <-2 SDS、至少进行了 1 次生长激素（GH）刺激试验，以及 IGF-I、IGFBP-3 和 ALS 同日测量。统计分析采用 ROC 以及优势比计算。

结果

47 名 90 名参与者的峰值 GH 值低于 7ng/mL 的截止值。仅包含 IGF-I 的模型的 AUC 为 0.76，仅包含 ALS 的 AUC 为 0.68。包含 IGF-I、IGFBP-3 和 ALS（AUC = 0.77）的模型与 IGF-I/IGFBP-3（0.77）或 IGF-I/ALS（0.76）的组合相比，并未改善结果。此外，仅由 IGF-I 解释的结果（GH 峰值 </≥7）的变异仅为 20.4%，而由 IGFBP-3 和 ALS 解释的变异仅分别为 10.6%和 7.8%。在各自浓度为-2.0 SDS 时，IGF-I 诊断 GHD 的敏感性为 48%，IGFBP-3 为 38%，而 ALS 仅为 8%。