吸入性糖皮质激素对哮喘儿童青春期生长及最终身高的影响。

Influence of inhaled corticosteroids on pubertal growth and final height in asthmatic children.

作者信息

De Leonibus Chiara, Attanasi Marina, Roze Zane, Martin Benedetta, Marcovecchio Maria Loredana, Di Pillo Sabrina, Chiarelli Francesco, Mohn Angelika

机构信息

Department of Pediatrics, University of Chieti, Chieti, Italy.

Riga Stradins University Faculty of Continuing Education, Children's Clinical University Hospital, Riga, Latvia.

出版信息

Pediatr Allergy Immunol. 2016 Aug;27(5):499-506. doi: 10.1111/pai.12558. Epub 2016 May 6.

DOI:10.1111/pai.12558

PMID:26919136

Abstract

BACKGROUND

Controversial data exist on the possibility that inhaled corticosteroids (ICs) affect growth in children with mild-to-moderate asthma. We assessed whether ICs affect growth and final height (FH) in asthmatic children compared to controls.

METHODS

A retrospective study was conducted on 113 asthmatic children compared with 66 control children. Asthmatic children presented with mild-to-moderate asthma and had exclusive ICs. Anthropometric data of four specific time-points were collected for both groups (pre-puberty, onset and late puberty, and FH) and converted to standard deviation scores (SDS). Growth trajectories were assessed as follows: (i) in puberty, using peak height velocity (PHV) and pubertal height gain SDS (PHG-SDS); (ii) until FH achievement, using FH-SDS and FH gain SDS (FHG-SDS). Repeated measurement analysis was performed across longitudinal study visits. A general linear model (GLM) was performed in asthmatic group evaluating the effect of corticosteroid type, treatment duration, and cumulative dose on FH corrected for multiple variables.

RESULTS

At pre-puberty, height and weight SDS were similar between the groups (p > 0.05). Height SDS progressively declined over the study period in asthmatic patients from pre-puberty to FH (p-trend < 0.05), whereas it did not change over time in controls (p-trend > 0.05), in both boys and girls. Asthmatic children had exclusive ICs [budesonide (n = 36) vs. fluticasone (n = 43) vs. mometasone (n = 34)] for a mean period of 6.25 ± 1.20 years and a mean cumulative dose of 560.07 ± 76.02 mg. They showed decreased PHG-SDS and lower PHV compared to controls (all p < 0.05). FH-SDS and FHG-SDS were significantly reduced in asthmatic group compared to controls. FH in asthmatic patients was 2.5 ± 2.89 cm lower in boys and 2.0 ± 2.03 cm lower in girls than controls. The GLM showed that FH achievement was dependent on the type of ICs, duration of the treatment, and cumulative dose (p < 0.05).

CONCLUSIONS

ICs affect pubertal growth determining reduced final height in asthmatic children compared to controls, in a dose- and duration-dependent manner.

摘要

背景

关于吸入性糖皮质激素（ICs）是否会影响轻至中度哮喘儿童的生长，存在有争议的数据。我们评估了与对照组相比，ICs是否会影响哮喘儿童的生长和最终身高（FH）。

方法

对113名哮喘儿童和66名对照儿童进行了一项回顾性研究。哮喘儿童表现为轻至中度哮喘且仅使用ICs。收集两组在四个特定时间点（青春期前、青春期开始和晚期以及FH）的人体测量数据，并转换为标准差分数（SDS）。生长轨迹评估如下：（i）在青春期，使用身高生长峰值速度（PHV）和青春期身高增长SDS（PHG-SDS）；（ii）直到达到FH，使用FH-SDS和FH增长SDS（FHG-SDS）。在纵向研究访视中进行重复测量分析。在哮喘组中进行了一般线性模型（GLM）分析，评估了糖皮质激素类型、治疗持续时间和累积剂量对校正了多个变量后的FH的影响。

结果

在青春期前，两组的身高和体重SDS相似（p>0.05）。在研究期间，哮喘患者从青春期前到FH的身高SDS逐渐下降（p趋势<0.05），而对照组的身高SDS随时间没有变化（p趋势>0.05），男孩和女孩均如此。哮喘儿童仅使用ICs[布地奈德（n = 36）、氟替卡松（n = 43）、莫米松（n = 34）]，平均使用时间为6.25±1.20年，平均累积剂量为560.07±76.02mg。与对照组相比，他们的PHG-SDS降低，PHV更低（所有p<0.05）。与对照组相比，哮喘组的FH-SDS和FHG-SDS显著降低。哮喘患者的FH在男孩中比对照组低2.5±2.89cm，在女孩中比对照组低2.0±2.03cm。GLM显示，FH的达成取决于ICs的类型、治疗持续时间和累积剂量（p<0.05）。