Bone and Endocrine Research Group, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
J Pediatr Gastroenterol Nutr. 2011 Jan;52(1):31-7. doi: 10.1097/MPG.0b013e3181edd797.
Treatment with antitumour necrosis factor-α therapy such as infliximab may improve growth in children with Crohn disease (CD), but the extent of improvement in growth and its relation to pubertal progress and glucocorticoid (GC) therapy are unclear. This is a retrospective study of growth, puberty, and disease activity during the 6 months before starting infliximab (T - 6), at baseline (T0), and for the following 6 months (T + 6) and 12 months (T + 12) in children with CD.
The growth and treatment details of 28 children (male, 17) who were given infliximab at a median (10th, 90th) age of 13.1 years (10.0, 15.7) were reviewed. Data on disease markers (C-reactive protein, erythrocyte sedimentation rate, and albumin), total alkaline phosphatase, and a physician's global assessment were also collected. Results are expressed as median (10th, 90th).
Of the 28 cases, 21 (75%) demonstrated a clinical response to infliximab treatment. Overall, height velocity (HV) increased from 3.6 cm/y (0.4-7.8) at T0 to 5.5 cm/y (2.1-9.2) at T + 6 (P = 0.003). In infliximab responders, HV increased from 2 cm/y (0.3-7.1) to 6.4 cm/y (2.3-9.1) (P = 0.004) and in the nonresponders, HV remained static at 4.3 cm/y (2.5-8.6) at T0 and 3.0 cm/y (2.0-11.3) (P = 0.701) at T + 6. HV also increased in the subgroup of 13 children who had remained prepubertal from 4.5 cm/y (0.4-8) to 5.5 cm/y (3.3-8.4) (P = 0.050). In the subgroup of 11 children who had a reduction (n = 2) or cessation in GC (n = 9), HV increased from 1.8 cm/y (0.3-8.3) at T0 to 5.6 cm/y (2.2-9.2) at T + 6 (P = 0.14), whereas those children who did not receive GC during the 12 months had an increase from 3.7 cm/y (0.6-6.5) to 6.4 cm/y (2.9-9.0) (P < 0.05). HV at T0 and T + 6 showed a significant association with the average alkaline phosphatase during the prior 6 months (r = 0.39, P < 0.05). HV did not show any association with individual markers of disease activity.
Clinical response to infliximab therapy is associated with an improvement in linear growth in the short term in children with CD. This increase in height may not be simply due to progress in pubertal status or reduction in GC dose.
使用抗肿瘤坏死因子-α 治疗，如英夫利昔单抗，可以改善克罗恩病（CD）患儿的生长情况，但生长改善的程度及其与青春期进展和糖皮质激素（GC）治疗的关系尚不清楚。这是一项回顾性研究，分析了 28 名 CD 患儿在开始英夫利昔单抗前 6 个月（T - 6）、基线（T0）以及随后的 6 个月（T + 6）和 12 个月（T + 12）期间的生长、青春期和疾病活动情况。
回顾了中位（第 10 分位、第 90 分位）年龄为 13.1 岁（10.0，15.7）的 28 名（男 17 名）接受英夫利昔单抗治疗的患儿的生长和治疗细节。还收集了疾病标志物（C 反应蛋白、红细胞沉降率和白蛋白）、总碱性磷酸酶和医生总体评估的数据。结果表示为中位数（第 10 分位、第 90 分位）。
28 例患儿中，21 例（75%）对英夫利昔单抗治疗有临床反应。总体而言，身高增速（HV）从 T0 时的 3.6 cm/y（0.4-7.8）增加到 T + 6 时的 5.5 cm/y（2.1-9.2）（P = 0.003）。在英夫利昔单抗应答者中，HV 从 2 cm/y（0.3-7.1）增加到 6.4 cm/y（2.3-9.1）（P = 0.004），而在无应答者中，HV 在 T0 时保持不变，为 4.3 cm/y（2.5-8.6），在 T + 6 时为 3.0 cm/y（2.0-11.3）（P = 0.701）。在 13 名仍处于青春期前的患儿亚组中，HV 也从 4.5 cm/y（0.4-8）增加到 5.5 cm/y（3.3-8.4）（P = 0.050）。在 11 名减少（n = 2）或停止使用 GC（n = 9）的患儿亚组中，HV 从 T0 时的 1.8 cm/y（0.3-8.3）增加到 T + 6 时的 5.6 cm/y（2.2-9.2）（P = 0.14），而在 12 个月内未接受 GC 的患儿 HV 从 3.7 cm/y（0.6-6.5）增加到 6.4 cm/y（2.9-9.0）（P < 0.05）。T0 和 T + 6 的 HV 与之前 6 个月的平均碱性磷酸酶呈显著相关（r = 0.39，P < 0.05）。HV 与疾病活动的单个标志物均无相关性。
英夫利昔单抗治疗的临床反应与 CD 患儿短期线性生长的改善相关。身高的这种增加可能不仅仅是由于青春期进展或 GC 剂量减少。
