中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
9期
655-661
,共7页
宗心南%李辉%张亚钦%张慧
宗心南%李輝%張亞欽%張慧
종심남%리휘%장아흠%장혜
身高%生长曲线表%纵向研究%儿童%青少年
身高%生長麯線錶%縱嚮研究%兒童%青少年
신고%생장곡선표%종향연구%인동%청소년
Body height%Growth charts%Longitudinal studies%Child%Adolescent
目的 通过体检检测数据,分析儿童青少年身高生长轨迹的变化规律,为儿科临床及保健医生早期识别生长偏离及评估干预治疗提供科学依据.方法 回顾性收集2006至2012年北京市东城区某两所普通学校4 632名中小学生体检监测数据,监测记录为1～8次.将每个对象第一次身高记录对应的Z分曲线定义为基线生长轨迹,计算不同时点身高随访测量围绕基线轨迹向上或向下的偏离量确定上下浮动区间数据,采用LIFEREG程序拟合参数回归模型.构建等距为0.67标准差(s)的生长轨道,计算处在不同基线Z区间轨道内身高随访测量沿基线轨道或偏离基线轨道运行的构成比.结果 将身高监测记录≥3次者3 308人纳入进行统计分析.本组资料身高浮动区间数据服从指数分布,拟合含性别和基线Z区间轨道两协变量的指数分布模型显示性别差异无统计学意义(P =0.186 6).将性别因素剔除后拟合只含有基线Z区间轨道的模型显示Z区间在＞2.00s和-2.00～-1.34 s差异均无统计学意义(P=0.946 7、0.091 1).将基线Z区间缩减为6个连续的轨道后,拟合出了精练的、差异有统计学意义的指数模型(P ＜0.000 1).处在不同轨道的个体,身高随基线轨迹上下浮动的偏离量有明显差异,高轨道向下浮动,低轨道向上浮动.总体上,90％的个体(P5～ P95)围绕基线轨迹上下浮动的偏离量范围为4.06 cm,其中向下浮动2.60 cm,向上浮动1.46 cm.个体在Z区间上半部(0～2.00 s)沿原生长轨道运行的比例为43.8％～47.4％,在下半部(-2.00 s～0)为33.0％ ～ 37.9％;在上半部运行不跨越±1个轨道的比例为94.0％～94.8％,在下半部为79.1％ ～91.0％.结论 儿童青少年身高生长轨迹的一般规律:90％的个体围绕基线轨迹上下浮动的偏离量范围约为4.00 cm,其中向下浮动2.00 ～3.00 cm,向上浮动1.00～2.00 cm;30％～50％的个体沿原生长轨道前进,80％ ～ 90％的个体运行不跨越±1个轨道.
目的 通過體檢檢測數據,分析兒童青少年身高生長軌跡的變化規律,為兒科臨床及保健醫生早期識彆生長偏離及評估榦預治療提供科學依據.方法 迴顧性收集2006至2012年北京市東城區某兩所普通學校4 632名中小學生體檢鑑測數據,鑑測記錄為1～8次.將每箇對象第一次身高記錄對應的Z分麯線定義為基線生長軌跡,計算不同時點身高隨訪測量圍繞基線軌跡嚮上或嚮下的偏離量確定上下浮動區間數據,採用LIFEREG程序擬閤參數迴歸模型.構建等距為0.67標準差(s)的生長軌道,計算處在不同基線Z區間軌道內身高隨訪測量沿基線軌道或偏離基線軌道運行的構成比.結果 將身高鑑測記錄≥3次者3 308人納入進行統計分析.本組資料身高浮動區間數據服從指數分佈,擬閤含性彆和基線Z區間軌道兩協變量的指數分佈模型顯示性彆差異無統計學意義(P =0.186 6).將性彆因素剔除後擬閤隻含有基線Z區間軌道的模型顯示Z區間在＞2.00s和-2.00～-1.34 s差異均無統計學意義(P=0.946 7、0.091 1).將基線Z區間縮減為6箇連續的軌道後,擬閤齣瞭精練的、差異有統計學意義的指數模型(P ＜0.000 1).處在不同軌道的箇體,身高隨基線軌跡上下浮動的偏離量有明顯差異,高軌道嚮下浮動,低軌道嚮上浮動.總體上,90％的箇體(P5～ P95)圍繞基線軌跡上下浮動的偏離量範圍為4.06 cm,其中嚮下浮動2.60 cm,嚮上浮動1.46 cm.箇體在Z區間上半部(0～2.00 s)沿原生長軌道運行的比例為43.8％～47.4％,在下半部(-2.00 s～0)為33.0％ ～ 37.9％;在上半部運行不跨越±1箇軌道的比例為94.0％～94.8％,在下半部為79.1％ ～91.0％.結論 兒童青少年身高生長軌跡的一般規律:90％的箇體圍繞基線軌跡上下浮動的偏離量範圍約為4.00 cm,其中嚮下浮動2.00 ～3.00 cm,嚮上浮動1.00～2.00 cm;30％～50％的箇體沿原生長軌道前進,80％ ～ 90％的箇體運行不跨越±1箇軌道.
목적 통과체검검측수거,분석인동청소년신고생장궤적적변화규률,위인과림상급보건의생조기식별생장편리급평고간예치료제공과학의거.방법 회고성수집2006지2012년북경시동성구모량소보통학교4 632명중소학생체검감측수거,감측기록위1～8차.장매개대상제일차신고기록대응적Z분곡선정의위기선생장궤적,계산불동시점신고수방측량위요기선궤적향상혹향하적편리량학정상하부동구간수거,채용LIFEREG정서의합삼수회귀모형.구건등거위0.67표준차(s)적생장궤도,계산처재불동기선Z구간궤도내신고수방측량연기선궤도혹편리기선궤도운행적구성비.결과 장신고감측기록≥3차자3 308인납입진행통계분석.본조자료신고부동구간수거복종지수분포,의합함성별화기선Z구간궤도량협변량적지수분포모형현시성별차이무통계학의의(P =0.186 6).장성별인소척제후의합지함유기선Z구간궤도적모형현시Z구간재＞2.00s화-2.00～-1.34 s차이균무통계학의의(P=0.946 7、0.091 1).장기선Z구간축감위6개련속적궤도후,의합출료정련적、차이유통계학의의적지수모형(P ＜0.000 1).처재불동궤도적개체,신고수기선궤적상하부동적편리량유명현차이,고궤도향하부동,저궤도향상부동.총체상,90％적개체(P5～ P95)위요기선궤적상하부동적편리량범위위4.06 cm,기중향하부동2.60 cm,향상부동1.46 cm.개체재Z구간상반부(0～2.00 s)연원생장궤도운행적비례위43.8％～47.4％,재하반부(-2.00 s～0)위33.0％ ～ 37.9％;재상반부운행불과월±1개궤도적비례위94.0％～94.8％,재하반부위79.1％ ～91.0％.결론 인동청소년신고생장궤적적일반규률:90％적개체위요기선궤적상하부동적편리량범위약위4.00 cm,기중향하부동2.00 ～3.00 cm,향상부동1.00～2.00 cm;30％～50％적개체연원생장궤도전진,80％ ～ 90％적개체운행불과월±1개궤도.
Objective Longitudinal studies in height for school-age children and adolescents mainly focused on the velocity,spurt and peak of growth,and currently no changing growth trajectory or channel around the baseline were reported except the shift of percentiles among infants.This study aimed to analyze general characteristic of the growth trajectory of height among children and adolescents so as to provide scientific evidence for early detecting height deviation and evaluating treatment interventions for pediatric clinical and health care professionals.Method Height measurement data of 4 632 school-aged children and adolescents were retrospectively collected from two middle schools in urban Beijing between 2006 and 2012,with physical examination records varying from 1 to 8 times.Corresponding Z-score curve of the first height data of each study subject was defined as the baseline growth trajectory.Interval censored data were determined by calculating and comparing the amount of up or down floating deviation of those follow-up measurements around the baseline trajectory at different time points,and the LIFEREG procedure was used to fit parametric regression model.Defined 0.67 s as isometric growth channel,proportions of follow-up measurements along the baseline or off-baseline channel were calculated at different baseline Z-score interval channel.Result Totally 3 308 subjects with height examination records of 3 times or more were included in this study.Interval censored data of height abide by the exponential distribution based on parametric regression model.The exponential distribution model with two covariates of sex and baseline Z-score interval channel showed that sex was not statistically significant (P =0.186 6).After removing factor of sex,the model only with baseline Z-score channel displayed that those Z-score channels over + 2.00 s (P =0.946 7) and-2.00-1.34 s (P =0.091 1) were not statistically significant with the control of the channel below-2.00 s.Refined exponential distribution model (P ＜ 0.000 1) was constructed after the Z-score channel reduced to six consecutive isometric growth channels.There were district differences in height deviations around the baseline trajectory in different baseline Z-score interval channels,floating downward in upper channel and floating upward in lower channel.Overall,the range of deviation of 4.06 cm was observed around the baseline trajectory in 90％ of individuals (from P5 to P95),with the floating down 2.60 cm and the floating up 1.46 cm.The proportions of the individuals growing along the original channel were 43.8％-47.4％ in the upper Z interval (0-2.00 s) and 33.0％-37.9％ in the lower Z interval (-2.00-0 s) ; the proportions not shifting ± 1 channel were 94.0％-94.8％ in the upper part and 79.1％-91.0％ in the lower part.Conclusion This study obtained general characteristics of growth trajectory of height among children and adolescents:the deflection range of shifting up and down is about 4 cm around the baseline trajectory for 90％ individuals,with the downward float 2.00-3.00 cm and the upward 1.00-2.00 cm ; and 30％-50％ individuals go along the baseline channel and 80％-90％ individuals do not exceed ± 1 channels.
