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【目的】探讨TW2-CHN RUS骨龄评测法对中枢性性早熟患儿骨龄评价的诊断价值,确定正常值临界点。【方法】选取中枢性性早熟患儿54例,对照组55例。由2名医生盲法读阅每一对象左手腕骨X线片,用TW2-CHNRUS标准测定骨龄,将骨龄与生理年龄差值(Δ)用SPSS 13.0进行ROC分析。【结果】两名医生骨龄评判的Kappa值为0.719(U=13.991,P<0.05),提示骨龄检查的一致性较高。ROC曲线下面积0.889,标准误(SE)为0.030,95%CI为0.829～0.948,曲线中最靠近左上角的工作点是Δ≥1.15岁,该点的敏感度为0.926,特异度为0.709,Youden指数为0.635,漏诊率和误诊率均较低。【结论】建议确定Δ≥1.15岁作为骨龄诊断性早熟的参考值临界点。
【Objective】 To investigate the diagnostic value of TW2-CHN RUS bone age assessment in evaluating bone age in children with central precocious puberty and to determine the critical point of normal value. 【Methods】 54 cases of central precocious puberty and 55 cases of control group were selected. The left wrist carotid radiographs of each subject were blindedly read by two doctors. The skeletal age was measured by TW2-CHNRUS standard. The difference between skeletal age and physiological age (Δ) was analyzed by ROC using SPSS 13.0. 【Results】 The Kappa value of the two doctors’ bone age assessment was 0.719 (U = 13.991, P <0.05), which indicated that the consistency of bone age was higher. The area under the ROC curve was 0.889, the standard error (SE) was 0.030 and the 95% CI was 0.829-0.948. The working point closest to the upper left corner of the curve was Δ≥1.15 years old, the sensitivity at this point was 0.926 and the specificity was 0.709. Youden index is 0.635, the rate of misdiagnosis and misdiagnosis are low. 【Conclusion】 It is suggested to determine Δ≥1.15 years as the critical point for the reference value of diagnosis of precocious puberty.