Application Of Serum Osteocalcin And Calcitonin In The Diagnosis And Treatment Of Girls With Central Idiopathic Precocious Puberty

In recent years,with the improvement of people's living standards,food and environment have gradually changed,and the number of precocious puberty children has increased year by year,which has become the focus of attention around the world.The prevention and treatment of precocious puberty has been quickly mentioned on the agenda.Children with precocious puberty have psychological hazards and social problems due to psychological immaturity,and their sexual development is often accompanied by accelerated bone growth,early fusion of the epiphysis,and eventually short stature in adulthood.At present,the clinical use of height,bone age,bone density and other tests to evaluate the treatment effect,these indicators have human factors,the lack of sensitivity and objectivity to the early evaluation of treatment.Moreover,few studies on the long-term bone metabolism in children treated with Gonadotropin releasing hormone analogue(GnRHa),combined with growth hormone(GH)of Idiopathic central precocious puberty(ICPP)have been reported on the long-term efficacy of improving adult height.Serum osteocalcin(OST)is an important biochemical indicator reflecting the activity of osteoblasts,especially newly formed osteoblasts.Calcitonin(CT)could inhibit osteoclast function,weaken osteolysis process and enhance the osteogenesis.At present,there are few studies on the diagnostic value of CT and OST for ICPP.Objective: To investigate the OST and CT serum levels between ICPP and healthy children before and after treatment with GnRHa or GnRHa-GH.To analyze the correlation between serum OST level with bone age and LH,analyze OST and CT by ROC curve.The diagnostic value of CT for ICPP provides a laboratory basis for the clinical diagnosis and treatment of ICPP.Methods: A total of 22 patients with ICPP who were admitted to the Department of Child gynecology in Hebei Children's Hospital from October 2013 to December 2014 were enrolled in the observation group.In the same period,20 healthy girls before puberty were selected as the control group.All patients were recorded on their medical history,physical examination,B-ultrasound examination of uterus and ovary,X-ray film detection of bone age,serum osteocalcin and calcitonin levels.The above indicators were measured before treatment and after 1 year of treatment.We compared the differences of serum OST and CT levels between children with ICPP and healthy children,and observed the changes of height,weight,serum OST and CT levels before and after treatment and their relationship with bone age.Using the ROC curve,the diagnosis value of serum osteocalcin and calcitonin on ICPP were analyzedResults:1.Comparison of serum OST and CT levels between children with ICPP and healthy children The serum OST level of children with ICPP was(88.88�29.56)ng/ml,which was significantly higher than that of healthy children(50.88�28.58)ng/ml(P<0.001).There was no significant difference in serum CT levels between the two groups(P=0.75).2.Comparison of serum OST and CT levels before and after treatment in ICPP patientsThere was no significant difference in serum OST level(88.88�29.56)ng/ml between patients with ICPP and serum osteocalcin level after treatment(88.3�29.4)ng/ml(P=0.946);serum CT level before treatment(1.91�2.20)There was no significant difference between ng/ml and(1.3�0.9)ng/ml after treatment(P=0.26).3.Correlation analysis between serum OST,CT and bone ageUsing bone age(Y)as the dependent variable,serum OST level(X1)and CT level(X2)as independent variables,and linear regression was performed.Serum osteocalcin=0.035X+4.8934(R=0.749,P<0.001)Serum OST was positively correlated with bone age;serum CT was not associated with bone age.4.The association between OST and LHSerum osteocalcin(OST)was positively correlated with LH level.Using LH(Y)as dependent variable,serum OST level(X)as independent variable,and linear regression was Y?=0.0281X-0.9804(R=0.941,P<0.001).5.Diagnostic value of serum OST and CT levels for ICPPThrough ROC curve analysis,serum OST has diagnostic value for ICPP.The area under the curve(AUC)is 0.825,95% CI is 0.697~0.953.According to the Yoden index,the optimal threshold for serum OST for the diagnosis of ICPP is 81.34ng/ Ml,sensitivity 63.6%,specificity 90.0%(P < 0.001).Serum CT had no diagnostic value for ICPP,and the AUC was 0.449(P=0.99).Conclusion: The serum OST level of children with ICPP is significantly higher than that of healthy children,which is related to bone age and has diagnostic value for ICPP.It can be used as an indicator of bone metabolism in the diagnosis and treatment of ICPP.