Cezard J P, Touati G, Alberti C, Hugot J P, Brinon C, Czernichow P
The French Group of Paediatric Gastroenterology and Nutrition, Hôpital Robert Debré, Paris, France.
Horm Res. 2002;58 Suppl 1:11-5. doi: 10.1159/000064759.
Growth failure (GF) is one of the major complications affecting children with inflammatory bowel disease. The faltering is temporary in 40-50% of cases and prolonged in 10-20% in Crohn's disease (CD). Such failure is rare in children with ulcerative colitis (5%). This complication is often associated with retarded bone development and delayed onset of sexual maturation. The delayed linear growth has a variety of causes including insufficient intake due to anorexia and the inflammatory process with increased energy and protein expenditure. Other factors are increased intestinal loss, secondary hypopituitarism and treatment with steroids. Therapeutic strategies of CD in children have changed this last decade by introducing new therapeutic agents such as topic steroids, immunosuppressors, anti-TNF (antibody and notably in children enteral nutrition which has shown its efficacy in inducing remissions of active CD, restoring nutritional status and stimulation of linear growth. The results of a recent prospective multicentric study over 2 years in 82 CD show that severe GF (-2 SD) is initially present in 15% (n = 12), among them 11 remain < -2SD after 2 years of follow-up. Six patients who were on the normal range initially increased their GF during the follow-up (< -2SD) (total 21% < -2SD (n = 17) at 2 years). At inclusion in this group there was no difference in growth velocity, used of steroids, enteral nutrition or severity of CD as compared to the group with no GF. It suggests that new treatment strategy should be developed in the future for this specific complication of paediatric CD.
生长发育迟缓（GF）是影响炎症性肠病患儿的主要并发症之一。在40%-50%的病例中，生长发育迟缓是暂时的，在克罗恩病（CD）中，10%-20%的病例会出现生长发育迟缓持续时间延长的情况。在溃疡性结肠炎患儿中，这种生长发育迟缓情况较为罕见（5%）。这种并发症常与骨骼发育迟缓以及性成熟延迟有关。线性生长延迟有多种原因，包括厌食导致的摄入不足以及炎症过程中能量和蛋白质消耗增加。其他因素还有肠道丢失增加、继发性垂体功能减退以及使用类固醇治疗。在过去十年中，儿童CD的治疗策略发生了变化，引入了新的治疗药物，如局部类固醇、免疫抑制剂、抗TNF（抗体），尤其是儿童肠内营养，其已显示出在诱导活动性CD缓解、恢复营养状况和刺激线性生长方面的疗效。最近一项对82例CD患儿进行的为期2年的前瞻性多中心研究结果表明，严重生长发育迟缓（-2标准差）最初出现在15%（n = 12）的患儿中，其中11例在随访2年后仍低于-2标准差。6例最初生长发育在正常范围的患儿在随访期间生长发育迟缓加剧（低于-2标准差）（2年后共有21%低于-2标准差（n = 17））。与无生长发育迟缓的患儿组相比，该组患儿在纳入研究时，生长速度、类固醇使用、肠内营养情况或CD严重程度并无差异。这表明未来应为儿童CD的这一特定并发症制定新的治疗策略。
