Stevenson Richard D, Conaway Mark, Chumlea W Cameron, Rosenbaum Peter, Fung Ellen B, Henderson Richard C, Worley Gordon, Liptak Gregory, O'Donnell Maureen, Samson-Fang Lisa, Stallings Virginia A
Department of Pediatrics, School of Medicine, University of Virginia, Kluge Children's Rehabilitation Center and Research Institute, 2270 Ivy Rd, Charlottesville, Virginia 22903, USA.
Pediatrics. 2006 Sep;118(3):1010-8. doi: 10.1542/peds.2006-0298.
Children with cerebral palsy frequently grow poorly. The purpose of this study was to describe observed growth patterns and their relationship to health and social participation in a representative sample of children with moderate-severe cerebral palsy.
In a 6-site, multicentered, region-based cross-sectional study, multiple sources were used to identify children with moderate or severe cerebral palsy. There were 273 children enrolled, 58% male, 71% white, with Gross Motor Function Classification System levels III (22%), IV (25%), or V (53%). Anthropometric measures included: weight, knee height, upper arm length, midupper arm muscle area, triceps skinfold, and subscapular skinfold. Intraobserver and interobserver reliability was established. Health care use (days in bed, days in hospital, and visits to doctor or emergency department) and social participation (days missed of school or of usual activities for child and family) over the preceding 4 weeks were measured by questionnaire. Growth curves were developed and z scores calculated for each of the 6 measures. Cluster analysis methodology was then used to create 3 distinct groups of subjects based on average z scores across the 6 measures chosen to provide an overview of growth.
Gender-specific growth curves with 10th, 25th, 50th, 75th, and 90th percentiles for each of the 6 measurements were created. Cluster analyses identified 3 clusters of subjects based on their average z scores for these measures. The subjects with the best growth had fewest days of health care use and fewest days of social participation missed, and the subjects with the worst growth had the most days of health care use and most days of participation missed.
Growth patterns in children with cerebral palsy were associated with their overall health and social participation. The role of these cerebral palsy-specific growth curves in clinical decision-making will require further study.
脑瘫患儿常常生长发育不良。本研究旨在描述中重度脑瘫患儿代表性样本中观察到的生长模式及其与健康和社会参与的关系。
在一项基于地区的6个站点多中心横断面研究中，通过多种来源识别中重度脑瘫患儿。共纳入273名儿童，其中58%为男性，71%为白人，按粗大运动功能分类系统分级，III级占22%，IV级占25%，V级占53%。人体测量指标包括：体重、膝高、上臂长度、上臂中部肌肉面积、肱三头肌皮褶厚度和肩胛下皮褶厚度。建立了观察者内和观察者间的可靠性。通过问卷调查前4周的医疗保健使用情况（卧床天数、住院天数以及看医生或急诊次数）和社会参与情况（儿童和家庭错过上学或日常活动的天数）。绘制生长曲线并计算6项指标各自的z评分。然后使用聚类分析方法，根据所选6项指标的平均z评分将受试者分为3个不同组，以概述生长情况。
为6项测量指标分别绘制了包含第10、25、50、75和90百分位数的性别特异性生长曲线。聚类分析根据这些指标的平均z评分将受试者分为3组。生长情况最佳的受试者医疗保健使用天数最少，社会参与错过天数最少；生长情况最差的受试者医疗保健使用天数最多，参与错过天数最多。
脑瘫患儿的生长模式与其整体健康和社会参与相关。这些特定于脑瘫的生长曲线在临床决策中的作用有待进一步研究。
