血清IGFBP-3、25(OH) D3对儿童矮小症的诊断效能及相加交互作用分析-现代医学

血清IGFBP-3、25(OH) D3对儿童矮小症的诊断效能及相加交互作用分析

单位：界首市人民医院儿科, 安徽界首 236500

关键词：矮小症儿童胰岛素样生长因子结合蛋白-3 25-羟维生素D3 骨密度相加交互作用

分类号：R725.8

出版年·卷·期（页码）：2026·54·第七期（1090-1097）

摘要：

目的：评估血清胰岛素样生长因子结合蛋白-3(IGFBP-3)及25-羟维生素D3[25(OH)D3]对儿童矮小症的诊断效能及相加交互作用。方法：收集102例2022年11月至2025年5月在本院治疗矮小症儿童102例作为观察组，另选取同期于本院体检且留有血清样本的健康儿童78例作为对照组，检测两组儿童血清IGFBP-3、25(OH)D3水平，并比较其体格指标(体质量、身高、体质量指数)、骨密度Z值。采用Pearson相关分析评估血清指标与体格指标及骨密度的相关性；采用Logistic回归分别构建仅含父母身高、仅含血清指标及联合模型3个诊断模型，Bootstrap法进行内部验证，分析两指标的相加交互作用。结果：观察组血清IGFBP-3、25(OH)D3、体质量、身高及父母身高均低于对照组(均P＜0.05)。观察组血清IGFBP-3与体质量、身高均呈正相关(r值分别为0.512、0.485，均P<0.001)，25(OH)D3与体质量、骨密度Z值均呈正相关(r值分别为0.578、0.405，均P<0.001)。父母身高、IGFBP-3、25(OH)D3均是矮小症的危险因素(均P＜0.05)。仅纳入血清指标模型的受试者工作特征曲线下面积(AUC)为0.973，联合父母身高指标后AUC为0.982。DeLong检验显示两者差异无统计学意义(P=0.106)。交互作用分析显示，低IGFBP-3与低25(OH)D3同时存在时，矮小症风险高于两者单独存在风险之和(RERI=3.81，Bootstrap 95%CI: 0.52~7.10)，协同效应为两者单独效应之和的1.45倍(SI=1.45，Bootstrap 95%CI: 1.06~1.98)。结论：儿童矮小症血清IGFBP-3、25(OH)D3水平较低，血清学指标联合检测对矮小症具有较高的辅助诊断价值，但该诊断效能的普遍性尚需外部验证。IGFBP-3、25(OH)D3低水平同时存在时对矮小症具有协同效应，临床应关注综合评估与早期干预。

Objective: To evaluate the diagnostic efficacy and additive interaction of serum insulin-like growth factor-binding protein-3(IGFBP-3) and 25-hydroxyvitamin D3[25(OH)D3] in children with short stature. Methods: A total of 102 children with short stature treated at our hospital from November 2022 to May 2025 were enrolled as the observation group(n=102), and 78 healthy children who underwent physical examinations and had retained serum samples during the same period were selected as the control group(n=78). Serum levels of IGFBP-3 and 25(OH)D3 were measured in both groups. Physical parameters(body weight, height, body mass index) and bone mineral density Z-scores were compared between the two groups. Pearson correlation analysis was used to assess the correlations between serum biomarkers and physical parameters as well as bone mineral density. Three diagnostic models(parental height only, serum markers only, and combined) were constructed using Logistic regression. Internal validation was conducted using the Bootstrap method, and the additive interaction between the two biomarkers was analyzed. Results: Serum IGFBP-3, 25(OH)D3, body weight, height and parental height in the observation group were lower than those in the control group(all P<0.05). In the observation group, Serum IGFBP-3 was positively correlated with body weight and height(r：0.512, 0.485, all P<0.001), 25(OH)D3 was positively correlated with body weight and bone density Z-score(r：0.578, 0.405, all P<0.001). Parental height, IGFBP-3 and 25(OH)D3 were risk factors for short stature(all P<0.05). The area under the receiver operating characteristic curve(AUC) of the serum-only model was 0.973, and increased to 0.982 when parental height was added. DeLong test showed no significant difference between the two models(P=0.106). Interaction analysis revealed that coexistence of low IGFBP-3 and low 25(OH)D3 conferred a risk higher than the sum of their individual risks(RERI=3.81, Bootstrap 95%CI：0.52-7.10), with a synergy index of 1.45(Bootstrap 95%CI: 1.06-1.98). Conclusion: Serum IGFBP-3 and 25(OH)D3 levels are low in children with short stature. Combined detection of serum markers has high auxiliary diagnostic value, but its generalizability requires external validation. The coexistence of low levels of both markers exerts a synergistic effect on short stature, warranting comprehensive assessment and early intervention.

参考文献：

[1] 王玉冰,顾威,曹慧,等.矮小症儿童生长激素治疗依从性分析[J].现代医学,2021,49(11):1323-1327.
[2] 时付坤,张岚,高宇,等.垂体影像组学联合MRI特征预测矮小症儿童生长激素状态[J].中国医学影像技术,2025,41(7):1073-1078.
[3] 罗丽丝,杨清雄,王燕,等.儿童肥胖症中IGF-1和IGFBP-3的水平及诊断价值[J].昆明医科大学学报,2025,46(1):123-128.
[4] 高璐璐,殷伏生,胡华靖,等.rhGH联合VD3滴剂辅助成长体操对矮小症患儿生长发育及25-(OH)D水平的干预作用探究[J].内蒙古医科大学学报,2022,44(2):165-168.
[5] 李娟,张学辉,张琴,等.GH/IGFs轴功能检测在矮小症儿童病因诊断中的应用及其临床意义[J].蚌埠医学院学报,2022(7):889-892.
[6] 许榛,葛丽萍,孙晶晶,等.外周血维生素D与IGF-1、IGFBP-3交互作用在特发性矮小症发病中的意义探究[J].中国优生与遗传杂志,2024,32(3):609-613.
[7] 中华医学会儿科学分会内分泌遗传代谢学组.矮身材儿童诊治指南[J].中华医学信息导报,2008,23(24):20-21.
[8] RANKE M B.Short and long-term effects of growth hormone in children and adolescents with GH deficiency[J].Front Endocrinol,2021,12:720419.
[9] COHEN L E,ROGOL A D.Children with idiopathic short stature:an expanding role for genetic investigation in their medical evaluation[J].Endocr Pract,2024,30(7):679-686.
[10] SAVARIRAYAN R,IRELAND P,IRVING M,et al.International Consensus Statement on the diagnosis,multidisciplinary management and lifelong care of individuals with achondroplasia[J].Nat Rev Endocrinol,2022,18(3):173-189.
[11] 钱昊,俞艳梅,吴琪,等.矮小症儿童骨密度与血清维生素D IGF-1 IGFBP-3的相关性分析[J].河北医学,2022,28(7):1148-1152.
[12] 贺莉,吕加利,李俊,等.血清皮质醇、胰岛素生长因子结合蛋白-3、25-羟维生素D在特发性矮小症患儿中的表达及意义[J].中国儿童保健杂志,2024,32(6):678-681,686.
[13] 余蓉蓉,张小燕.矮小症患儿血清维生素D、相关元素及其与患儿体格、生长激素、胰岛素样生长因子-1的相关性[J].中国现代医学杂志,2022,32(9):78-83.
[14] 宋梅,刘瀚文,王静娜,等.血清Nesfatin-1、IGFBP-3、FGF-21联合检测对特发性矮小症的诊断价值[J].标记免疫分析与临床,2024,31(4):658-665.
[15] 邓茜,陈雨青,王娟娟,等.特发性矮小症患儿治疗前后血清IGF-1、IGFBP-3、25(OH)D、皮质醇水平变化及其与体格发育和骨龄的相关性分析[J].现代生物医学进展,2022,22(18):3524-3527,3595.
[16] 张静静,贾媛媛,胡苗苗,等.重组人生长激素对特发性矮小症儿童血清IGF-1/IGFBP-3摩尔比的影响及其临床意义[J].东南大学学报(医学版),2023,42(5):681-687.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录