Hernández M, Argente J, Navarro A, Caballo N, Barrios V, Hervás F, Polanco I
Departamento de Pediatría, Universidad Autónoma de Madrid, Hospital Infantil Niño Jesús, Madrid, España.
Horm Res. 1992;38 Suppl 1:79-84. doi: 10.1159/000182576.
Coeliac disease in children is frequently associated with a slow growth rate. This observation may be linked to the malabsorption that occurs in these patients; however, the underlying mechanism remains unknown. To better understand this phenomenon, we have studied the growth patterns of 153 patients with coeliac disease for 2-9 years. Gastro-intestinal biopsies were performed before and after gluten exclusion. In a second group of 79 children, somatostatin levels and binding properties in the plasma and jejunal mucosa were measured. In a third group of 40 patients we measured insulin-like growth factor I (IGF-I) and IGF-binding protein 3 (IGF-BP3) levels. We found that in children diagnosed before 2 years of age weight was the most affected growth parameter. In children diagnosed after this age, height was more affected. Suppression of gluten intake induced an acceleration of growth velocity. Although plasma levels of somatostatin were not significantly altered, somatostatin concentrations in the jejunal mucosa of patients in the active phase of the disease were significantly elevated (p < 0.05). Children with coeliac disease exhibited significantly lower levels of IGF-BP3 when compared to patients with normal stature and growth velocities. In contrast, these patients showed an increase in IGF-BP3 levels after gluten exclusion from the diet.
儿童乳糜泻常与生长速度缓慢相关。这一观察结果可能与这些患者发生的吸收不良有关；然而，其潜在机制仍不清楚。为了更好地理解这一现象，我们对153例乳糜泻患者的生长模式进行了2至9年的研究。在排除麸质前后进行了胃肠道活检。在另一组79名儿童中，测量了血浆和空肠黏膜中的生长抑素水平及结合特性。在第三组40例患者中，我们测量了胰岛素样生长因子I（IGF-I）和IGF结合蛋白3（IGF-BP3）的水平。我们发现，在2岁前被诊断出的儿童中，体重是受影响最大的生长参数。在这个年龄之后被诊断出的儿童中，身高受影响更大。麸质摄入量的抑制导致生长速度加快。虽然生长抑素的血浆水平没有显著改变，但疾病活动期患者空肠黏膜中的生长抑素浓度显著升高（p < 0.05）。与身材和生长速度正常的患者相比，乳糜泻患儿的IGF-BP3水平显著降低。相反，这些患者在饮食中排除麸质后，IGF-BP3水平有所升高。
