Simon Dominique, Lucidarme Nadine, Prieur Anne-Marie, Ruiz Jean-Charles, Czernichow Paul
Service d'Endocrinologie et de Diabétologie Pediatriques, Hôpital Robert Debré, Paris, France.
Horm Res. 2002;58 Suppl 1:28-32. doi: 10.1159/000064770.
We retrospectively assessed linear growth and final height in a group of 24 patients suffering from juvenile idiopathic arthritis (JIA) during childhood, receiving steroid therapy. In these patients, a significant loss of height (-2.7 +/- 1.5 SDS) occurred in the first years of the disease which was positively correlated with prednisone therapy duration. After remission of the disease and prednisone discontinuation, most of the patients (70%) had catch-up growth but 30% had a persistent loss of height. Their mean final height was strongly correlated with their mean height at the end of steroid therapy and was significantly different between the group of patients with catch-up growth (-1.5 +/- 1.6 SDS) and the group without catch-up growth (-3.6 +/- 1.2 SDS). This pattern of growth observed in JIA patients should help us to define strategies of GH treatment in these patients in order to improve their final height. We have previously reported the beneficial effects on growth and body composition of a 1-year GH treatment in a group of 14 growth-retarded patients suffering from juvenile idiopathic arthritis, receiving glucocorticoid therapy. These patients (n = 13) were treated again with GH at the same dosage (0.46 mg/kg/week) for another 3-year period. GH treatment markedly increased growth velocity in these patients, but had a minor effect on SDS height suggesting that these children will remain short at adult age. Using GH earlier in these patients during the course of their disease may prevent growth deterioration and metabolic complications induced by chronic inflammation and long-term steroid therapy.
我们回顾性评估了一组24例儿童期患幼年特发性关节炎（JIA）且接受类固醇治疗的患者的线性生长和最终身高。在这些患者中，疾病最初几年出现了显著的身高丢失（-2.7±1.5 SDS），这与泼尼松治疗持续时间呈正相关。疾病缓解且停用泼尼松后，大多数患者（70%）实现了追赶生长，但30%的患者身高持续丢失。他们的平均最终身高与类固醇治疗结束时的平均身高密切相关，在有追赶生长的患者组（-1.5±1.6 SDS）和无追赶生长的患者组（-3.6±1.2 SDS）之间存在显著差异。在JIA患者中观察到的这种生长模式应有助于我们确定这些患者的生长激素（GH）治疗策略，以改善他们的最终身高。我们之前报道了一组14例患幼年特发性关节炎且接受糖皮质激素治疗的生长迟缓患者接受1年GH治疗对生长和身体成分的有益影响。这些患者（n = 13）再次以相同剂量（0.46 mg/kg/周）接受3年的GH治疗。GH治疗显著提高了这些患者的生长速度，但对SDS身高影响较小，表明这些儿童成年后仍会身材矮小。在这些患者疾病过程中更早使用GH可能会预防慢性炎症和长期类固醇治疗引起的生长恶化和代谢并发症。
