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河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师(或指导小组)的指导下,由本人独立完成。本学位论文研究所获得的研究成果,其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文,第一署名单位为河北医科大学,试验材料、原始数据、申报的专利等知识产权均归河北医科大学所有。否则,承担相应的法律责任。碱蝼轹掰翮签河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果,除了文中特别加以标注等内容外,文中不包含其他人已发表或撰写的研究成果,指导教师对此进行了审定。本论文由本人独立撰写,文责自负。研究生签名:辟学乎 :猡印 糜鬻露目 录中文摘要1英文摘要4研究论文多种骨龄测评方法的比较研究前言7刖舌一。7材料与方法8结果9附图11附表12讨论14结论1 6参考文献1 7综述 骨龄在临床实践中的应用20致谢3 1个人简历32中文摘要多种骨龄测评方法的比较研究摘 要目的:目前我国常用骨龄测评方法包括G-P图谱法、TW2法、TW3法、CHN法和中华05法等。这些骨龄测评方法的制定依据不同年代、不同地域的不同人群,呈现地域性、种族性、时间性的特点。我们在临床应用中发现,同一张骨龄片采用不同评价方法,所得出的骨龄结果差异较大。我国不同儿童内分泌机构使用不同的骨龄测评方法,不便交流。在诸种骨龄评价方法中,应用哪种方法判断骨龄更能反映儿童实际骨龄状况,是困扰儿童临床内分泌医生的问题。通过对同一骨龄片同时采用几种骨龄测评方法进行比较,探索出适合河北地区女童的、适合不同年龄段的骨龄评测方法。方法:研究对象来自201 1年8月份于河北医科大学第二医院儿科生长发育门诊免费体检的240例健康女童,年龄范围是415岁,身高位于同龄正常女童的平均身高+2SD范围之内,体重位于同龄正常女童平均体重士2SD范围之内。排除患有内分泌疾病或用过激素类药物者。按照年龄分为5个年龄组,4-+6岁,68岁,8lO岁,1012岁,1215岁。分别采用G-P图谱法、CHN法、TW2。RUS法、TW2C法、TW2T法、TW3法、ImSCHN法和TW3。C RUS法8种标准评价每名儿童骨龄,计算不同方法骨龄与生活年龄的差值,应用单样本t检验检验差值与零检验值之间的差异显著性。各项指标以均数标准差(页s)表示。应用秩和检验检验同一年龄组内不同测评方法之间的差异性。SpearmanS秩相关用来评估骨龄与年龄之间的关联性。PO05)外,其余方法骨龄与生活年龄差值均数与零检验值之间差异均有统计学意义(PO05)外,其余方法骨龄与生活年龄差值均数与零检验值之间差异均有统计学意义(尸O05)外,其余方法骨龄与生活年龄差值平均数,与零检验值之间差异均有统计学意义(尸O05)。其中CHN法、TW2R法、TW2C法有显著差异性(PO01)。GP法、RUSCHN法、TW3一C RUS法三种方法之间有差异性(PO01),其中GP法与RUSCHN法、G-P法与TW3C RUS法比较有差异性(PO05)。8种骨龄测评方法所得骨龄与生活年龄均呈正相关,相关系数r分别为0581、0465、0508、0583、0572、05 19、05 14、O534。P值均小于OOl。4 10一12岁年龄组,8种骨龄测评方法所得骨龄与生活年龄差值均数分别为0070、0304、0326、0043、0399、一0024、一0104、0289。除G-P法、TW2C法、TW3法、RUSCHN法(尸O05)外,其余方法骨龄与生活年龄差值平均数,与零检验值之间差异均有显著差异性(尸O05)。8种骨龄测评方法所得骨龄与生活年龄均呈正相关,相关系数r分别为0305、0335、0402、0263、0352、0393、0374、0388。尸值均小于O05。5 1215岁年龄组,8种骨龄测评方法所得骨龄与生活年龄差值均数分别为0770、0700、1291、-0124、O115、0527、0015、0348。除TW2C法、TW2T法、RUSCHN法(尸O05)外,其余方法骨龄与生活年龄差值平均数,与零检验值之间差异均有显著差异性(尸O05)。2中文摘要6各年龄组中,TW3法和TW3C RUS法之间是有显著差异性的(尸O05),其余各组三者之间是有差异性的(尸O05)。8八种骨龄测评方法所得骨龄与生活年龄均呈正相关,相关系数r分别为0808、O816、0806、0694、0775、0835、0797、0811。P值均小于O01。结论:1 8岁以前儿童测评骨龄,适合选用CHN法。2 810岁儿童测评骨龄,适合选用G-P法、RUSCHN法、TW3CRUS法,其中RUSCHN法骨龄与生活年龄差值最小。3 1012岁儿童测评骨龄,适合选用G-P法、TW2C法、TW3法、RUSCHN法,它们是没有差别的。4 1215岁儿童测评骨龄,适合选用TW2C法、TW2T法、RUSCHN法,它们是没有差别的。5 RUSCHN法适合8岁以后的儿童。关键词:骨龄测评;发育;骨龄;生活年龄;儿童英文摘要Comparison between bone ages assessed by several methodsABSTACTObjective:At present,the commonly used methods of bone ageassessment is GP Atlas,TW2,TW3,CHN and China-05 methodsDifferentmethods came from different populations of different regions,they haveregional,ethnic and timing characteristicsIn the clinic,we found that thereare great differences between bone ages assessed by different methodsIt isnot convenient to communicate that different endotrine centers use differentmethodSWhich method is best for children?It is a problem for clinicalendocrine doCtorsThe bone ages assessed by eight methods were compared totest the applicability of them in contemporary Hebei area girls of different agegroupsMethod:Our study included 240 health girls between 4 and 1 5 years oldreferred to the department of pediatrics endocrinology,nutrition,growthdevelopment at the second hospital of Hebei Medical University,for the freehealth examination in August 20 1 1Girls were considered as normal if theheight and weight were within normal range(mean+2SD)Girls withendocrine disorders or used hormone drugs were excluded舶m the studyAccording to the ages,240 girls were divided into five groups,46 years old,6-8 years old,8-10 years old,10-12 years old,12-15 years oldThe boneages of children were estimated by G-P Atlas,CHN,TW2RUS,TW2C,TW2一T,TW3,RUSCHN,TW3 RUSC methodsThe differences betweenbone age(BA)and chronological age(CA)for every method were calculatedand tested by One Sample T TestThe differences between methods within thesame age group were tested by Nonparametric TestsSpearmanS rankcorrelation Was used to evaluate correlation between BA and CAA p value ofO05 Was considered statistically significantResults:4英文摘要l 46 age group,the means of differences between BA estimated byeight methods and CA were-0307,008 1,0330,0333,024 1,-0822,一0452,一0663In addition to the Cmethod005),the means of differencesbetween BA and CA had significant differences with 0 test values仔005)BA estimated by eight methods and CA were positively correlated,thecorrelation coe伍cient r were 0809,0782,0749,0807,0806,0754,0806,0754P values were less than 0012 68 age group,the means of differences between BA estimated byeight methods and CA were一0208,-0003,0292,O508,0367,-0950,一0650,一O742In addition to the CHN method005),the means of differencesbetween BA and CA had significant differences with 0 test values(尸005)BA estimated by eight methods and CA were positively correlated,。thecorrelation coe伍cient r were O599,O64 1,0492,O666,0675,0465,0439,0395P values were less than 0053 81 0 age group,the means of differences between BA estimated byeight methods and CA were 0237,0459,0611,0580,0194,-0279,-0107,一O1 60In addition to the G-P Atlas,RUSC卸N and TW3-C I过,S methodsp005),the means of differences between BA and CA had significantdifferences with 0 test values畔005)Among them,C酬,TW2一R andTW2一C methods had notable significant differences僻001)The differencesamong G-P Atlas,RUSCHN and TW3一C RUS,tested by Nonparametric Tests,had significant differences映00 1)111e difference between G-P Atlas andRUSChad significant differences职00 1),the difference between GPAtlas and TW3一C RUS had significant differences职00 1),but,thedifference between RUSCHN and TW3C RUS had no significantdifferences咿005)BA estimated by eight methods and CA were positivelycorrelated,the correlation coe伍cient r were 058 1,0465,0508,0583,0572,0,519,O514,0534Pvalues were less than O014 1 O1 2 age group,the means of differences between BA estimated byeight methods and CA were 0070,0304,0326,0043,-0399,一O024,一01 04,0289In addition to the GP Atlas,TW2一C,TW3 and RUSCHN me廿10ds5英文摘要(胗005),the mealls of differences between BA and CA had notablesignificant differences谢nl 0 test values(尸O05)BA estimated by eight methods and CA werepositively correlated,the correlation coefficient r were 0305,O335,0402,0263,0352,0393,0374,0388P values were less than O055 1 21 5 age group,the means of differences between BA estimated byeight methods and CA were 0770,0700,129 1,-O1 24,O1 1 5,0527,一00 1 5,0348In addition to TW2一C,TW2一T and RUSCHN methods(胗005),themeans of differences between BA and CA had notable significant differences谢t11 0 test values(PO0 1)The differences among TW2-C,TW2-T andRUSCHN,tested by Nonparametfic Tests,had no significant differences(胗O05)6 In Each age group,the difference between”3 and们矿3一C RUSmethod had notable significant differences俨O0 1)7 In addition to the 46 age group咿005),the differences amongTW2-R,TW2-C and TW2-T had significant differences B005)8 BA estimated by eight methods and CA were positively correlated,thecorrelation coe伍cient r were 0808,O816,O806,0694,0775,0835,0797,O811P values were less than 001Conclusion:1 CHN method is applicable for girls before eight years2 RUSCHN,TW3一C RUS and RUSCHN methods are applicable forgirls aged 81 0yearsThe RUSCHN method is the best3 The G-P Atlas,TW2-C,TW3 and RUSCHN methods are applicable forgirls aged 1 01 2yearsThey have no difference4 TW2一C,TW2一T and RUSCHN methods are applicable for girls aged1 21 5years111ey have no difference,but The RUSCHN method is the best5 RUSCHN method is applicable for girls after the age of eightKey words: Bone age assessment;Development;Bone age;Chronologi

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