Pôle de Santé Publique, Parc Eurasanté, University Hospital, Université de Lille 2 EA2694, Lille Cedex, France.
Am J Gastroenterol. 2010 Aug;105(8):1893-900. doi: 10.1038/ajg.2010.20. Epub 2010 Feb 9.
Growth retardation and malnutrition are major features of pediatric Crohn's disease (CD). We examined nutritional and growth parameters from diagnosis to maximal follow-up in a population-based pediatric cohort, and we determined predictive factors.
A total of 261 patients (156 boys, 105 girls) with onset of CD before the age of 17 were identified from 1988 to 2004 through the EPIMAD registry (Registre des Maladies Inflammatoires Chroniques de l'Intestin) in northern France. Median age at diagnosis was 13 years (11.2-15.4) and median follow-up was 73 months (46-114). Z-scores of height/age, weight/age, and body mass index (BMI)/age were determined. Multivariate stepwise regression analysis identified predictive factors for malnutrition and growth retardation at maximal follow-up.
At diagnosis, 25 children (9.5%) showed height less than -2 s.d., 70 (27%) weight less than -2 s.d., and 84 (32%) BMI less than -2 s.d. At maximal follow-up, growth retardation was present in 18 children (6.9%), whereas 40 (15%) had malnutrition. Nutritional status was more severely impaired in children with stricturing disease. Growth and nutritional retardation at diagnosis, young age, male gender, and extraintestinal manifestations at diagnosis were indicators of poor prognosis. A significant compensation was observed for weight and BMI in both genders and for height in girls. No treatment was associated with height, weight, or BMI at maximal follow-up.
In our pediatric population-based study, growth retardation and severe malnutrition were still present at maximal follow-up in 6.9 and 15% of CD children, respectively. Young boys with substantial inflammatory manifestations of CD have a higher risk of subsequent growth failure, especially when growth retardation is present at diagnosis.
生长迟缓与营养不良是儿科克罗恩病（CD）的主要特征。我们在一个基于人群的儿科队列中，从诊断至随访末期，对营养和生长参数进行了研究，并确定了预测因素。
1988 年至 2004 年，我们通过法国北部 EPIMAD 注册中心（Registre des Maladies Inflammatoires Chroniques de l'Intestin）发现了 261 例起病年龄<17 岁的 CD 患儿（男 156 例，女 105 例）。诊断时的中位年龄为 13 岁（11.2-15.4），中位随访时间为 73 个月（46-114）。确定身高/年龄、体重/年龄和体重指数（BMI）/年龄的 Z 评分。多变量逐步回归分析确定了随访末期营养不良和生长迟缓的预测因素。
在诊断时，25 例患儿（9.5%）身高低于-2 s.d.，70 例（27%）体重低于-2 s.d.，84 例（32%）BMI 低于-2 s.d.。在随访末期，18 例患儿（6.9%）存在生长迟缓，而 40 例患儿（15%）存在营养不良。狭窄性疾病患儿的营养状况更严重受损。诊断时的生长和营养迟缓、年龄较小、男性和诊断时的肠外表现是预后不良的指标。两性的体重和 BMI 以及女孩的身高均有显著的代偿。在随访末期，治疗与身高、体重或 BMI 均无相关性。
在我们的儿科人群研究中，6.9%的 CD 患儿和 15%的患儿在随访末期仍存在生长迟缓及严重营养不良。具有大量炎症表现的年轻男性 CD 患儿随后出现生长衰竭的风险更高，尤其是在诊断时存在生长迟缓的情况下。
