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(GHD)的诊断价值。方法 79例生长迟缓儿童，根据生长学资料、临床表现及血胰岛素样生长因子I (IGF—I)、胰岛素样生长因子结合蛋白3(IGFBP一3)水平分为临床拟诊GHD组(39例)与非GHD(NGHD) 组(4O例)，全部进行PD+L-dopa联合激发并随机分别另行精氨酸激发试验(ARG，43例)或胰岛素耐量试 验(I1fr，36例)。比较三种试验的生长激素(GH)激发峰值及诊断敏感度、特异度、精确度，绘制受试者工 作特性曲线(ROC)及精确度曲线。结果 PD+L—dopa联合激发试验GH峰值在NGHD组高于ARG(P< 0．01)或I1fr(P<0．05)，在GHD组差异无显著性。PD+L．dopa联合激发试验的准确度、特异度明显高于 ARG或I1fr，敏感度与ARG或I1fr相近。GH峰值取7 g／L为正常截断值时，PD+L—dopa联合激发试验的 敏感度、特异度与准确度均最高，超过80％。结论 PD+L-dopa联合激发试验对儿童GHD诊断价值优于 ARG或I，rI’，是一种适合儿童的有效、简便、安全的检测手段。 【关键词】生长激素缺乏症；诊断；生长激素激发试验；吡啶斯的明；左旋多巴；胰岛素 Diagnostic value of provocative test by pyridostigmine combined with ievodopa for growth hormone deficiency in children LI Yah—hong．DU lVfin—lian，MA Hua—mei．HE Qiao—hua，LAI Feng．GU Yufen． Department ofPediatrics，The First Hospital Affiliated to Sun Yat—Sen University，Guangzhou 510080 【Abstract】 0bjective To evaluate the diagnostic value of provocative test by pyridostigmine(PD) combined with levodopa(L—dopa)for growth hormone deficiency(GHD)during childhood．Methods Seventy nine children with growt h retardation were enrolled in the study and were divided into 2 groups．Group GHD comprised 39 children with the appropriate auxological characteristics and the typical phenotypic features of GHD， and their serum levels of insulin．1ike growth faetor I (IGF—I)and insulin，like growth factor binding protein 3 (IGFBP 3)were 2 SDS below average concentrations．Group NGHD (non—GHD)comprised 40 children in whom GHD was excluded．A1l children underwent a provocative test with PD combined with L．dopa．Among them 。43 children underwent ar f "nine(ARG)provocative test while 36 children insulin tolerance test(I，rI’)．11he mean growth hormone(GH)peak response to PD+L．dopa test was compared with that to ARG test or to I1fr，and the diagnostic value including sensitivity，specificity and accuracy of each test was evaluated．Receiver operating characteristics curve (ROC)and accuracy curve for the PD +L-dopa test were made in order to determine the appropriate cut．off point of GH peak．Results In NGHD children the mean peak GH response to PD +L-dopa test was obviously higher than that to ARG test(P<0．01)or to ITT(P<0．05)，while in GHD children，the mean tt‘ E I t t It tlII lI _ l-I _II-一一I -- l I l l I l I I I l I I 鼍l 娶匿善匿睦 匿重匡 匿E 屋 篷匿 垒 peak GH response to PD +L．dopa test showed no di f erence from that to I1fr or ARG test．The specificity of PD + L．dopa test(42．1％，61．9％)was remarkably higherthan that of ARG test(21．1％)or ITr(42．9％)，whereas the sensitivity(95．8％，86．7％)was similar to ARG test(95．8％)or ITr(93．3％)．PD+L—dopa test had a better accuracy(72．1％，72．2％)than that of ARG test(62．8％)or ITr(63．9％)．When estimated from the test accuracy and the ROC curve．PD +L—dopa test had the best diagnostic value at the peak GH cut．o矗level of 7 g／L，with specificity，sensitivity and accuracy exceeding 80％．Conclusion The diagnostic value of PD 十L— dopa test is better than that of I1fr or ARG test．The provocative test using PD combined with L-dopa，is a convenient．useful and sate diagnostic means in short children． 【Key words】 Growth hormone deficiency；Diagnosis；Growth hormone provocative test；Pyridostigmine；