Ahmed S F, Sävendahl L
Bone and Endocrine Research Group, Division of Developmental Medicine, University of Glasgow, Royal Hospital for Sick Children, Glasgow, UK.
Horm Res. 2009 Nov;72 Suppl 1:42-7. doi: 10.1159/000229763. Epub 2009 Nov 27.
Growth disorders are commonly observed in children with chronic inflammatory disease. It is likely that these disorders are mediated by a combination of factors, including the disease process and its treatment (with drugs such as glucocorticoids [GCs]). These factors affect the growth hormone-insulin-like growth factor I (IGF-I) axis, which is crucial for promoting linear growth at the level of the growth plate. Recent advances in our knowledge of the effects of GCs and proinflammatory cytokines on the growth plate have led to an improved understanding of the biological rationale for the use of growth-promoting therapy in children with chronic inflammatory disease and concurrent growth retardation.
Both GCs and proinflammatory cytokines can adversely affect a number of components of growth plate chondrogenesis, and these effects can be ameliorated by raising local IGF-I exposure. However, this intervention does not lead to complete normalization of the growth plate. In children with chronic inflammation, the cornerstone of improving growth remains the judicious use of GCs while ensuring effective control of the disease process.
生长障碍在患有慢性炎症性疾病的儿童中很常见。这些障碍可能是由多种因素共同介导的，包括疾病进程及其治疗（使用糖皮质激素[GCs]等药物）。这些因素会影响生长激素 - 胰岛素样生长因子I（IGF - I）轴，而该轴对于在生长板水平促进线性生长至关重要。我们对糖皮质激素和促炎细胞因子对生长板影响的认识的最新进展，使我们对在患有慢性炎症性疾病和并发生长迟缓的儿童中使用促进生长疗法的生物学原理有了更好的理解。
糖皮质激素和促炎细胞因子均可对生长板软骨生成的多个成分产生不利影响，通过增加局部IGF - I暴露可改善这些影响。然而，这种干预并不能使生长板完全恢复正常。在患有慢性炎症的儿童中，改善生长的基石仍然是明智地使用糖皮质激素，同时确保有效控制疾病进程。
