Department of Pediatrics, University of California, San Francisco, California 94143, USA.
Inflamm Bowel Dis. 2013 Jan;19(1):61-5. doi: 10.1002/ibd.22979.
Impaired growth and delayed puberty are common in pediatric Crohn's disease (CD). Bone age (BA) is important for interpretation of statural growth. Our aims were to 1) determine the distribution of BA-Z scores; 2) identify clinical factors associated with BA-Z scores; and 3) compare anthropometric Z scores based on chronological age (CA) (CA-Z) versus BA-Z in pediatric CD.
CD patients ≤ CA 15 in females and 17 years in males were enrolled in a cross-sectional study. BA was determined with left hand/ wrist x-ray. In all, 49 patients (65% male; 84% Caucasian; mean CA 13 years) examined between January 2007 and July 2009 qualified for the study.
Mean BA-Z score was -1.40 ± 1.50 (standard deviation). 41% had BA-Z score < -2.0. Mean BA-Z scores were lower in females (P = 0.02), Caucasians (P = 0.006), Tanner stage 1-3 children (P = 0.004), and patients with colonic disease (P = 0.0006), past corticosteroid exposure (P = 0.01), current azathioprine/6-mercaptopurine treatment (P = 0.003), or lower height (P = 0.006), weight (P < 0.001), or body mass index (BMI) (P = 0.01) CA-Z scores. Mean height, weight, and BMI BA-Z scores were 0.73 units (P < 0.0001), 0.51 units (P < 0.0001), and 0.23 units (P < 0.0001) greater than mean height, weight, and BMI CA-Z scores.
Low BA occurs frequently in CD. Determination of BA should become the standard of care in pediatric CD patients, allowing clinically meaningful interpretation of growth in the context of skeletal maturation, leading to improved treatment recommendations, as growth is a dynamic marker of disease status. Prospective longitudinal studies are required to clarify determinants of BA and patterns of BA advancement in CD.
在儿科克罗恩病（CD）中，生长受损和青春期延迟很常见。骨龄（BA）对于解释身高生长非常重要。我们的目的是：1）确定 BA-Z 分数的分布；2）确定与 BA-Z 分数相关的临床因素；3）比较基于实际年龄（CA）（CA-Z）和 BA 的儿科 CD 患者的人体测量 Z 分数。
2007 年 1 月至 2009 年 7 月间，我们对接受了左手/腕 X 射线检查的女性≤CA15 岁和男性≤CA17 岁的 CD 患者进行了一项横断面研究。共 49 例患者（65%为男性；84%为白种人；平均 CA13 岁）符合研究条件。
平均 BA-Z 评分-1.40±1.50（标准差）。41%的患者 BA-Z 评分＜-2.0。女性（P=0.02）、白种人（P=0.006）、Tanner 分期 1-3 期的儿童（P=0.004）、结肠疾病患者（P=0.0006）、既往接受皮质类固醇治疗（P=0.01）、当前接受硫唑嘌呤/6-巯基嘌呤治疗（P=0.003）或 CA-Z 评分较低的患者（P=0.006）的 BA-Z 评分较低。平均身高、体重和 BMI 的 BA-Z 评分分别比 CA-Z 评分高 0.73 个单位（P＜0.0001）、0.51 个单位（P＜0.0001）和 0.23 个单位（P＜0.0001）。
在 CD 中，BA 低的情况很常见。在儿科 CD 患者中，应将 BA 的确定作为标准治疗方法，以便根据骨骼成熟情况对生长进行有意义的临床解释，从而提出更好的治疗建议，因为生长是疾病状态的动态标志物。需要进行前瞻性纵向研究以阐明 BA 的决定因素和 CD 中 BA 进展的模式。
