Ley Delphine, Duhamel Alain, Behal Hélène, Vasseur Francis, Sarter Hélène, Michaud Laurent, Gower-Rousseau Corinne, Turck Dominique
*Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Lille University Jeanne de Flandre Children's Hospital †Biostatistics Unit, Lille University Hospital, EA 2694 ‡Department of Public Health, Epidemiology and Economic Health, Epimad Registry, Lille University Hospital, University of Lille §Lille Inflammation Research International Centre LIRIC UMR 995, University of Lille, Inserm, CHU Lille, Lille, France.
J Pediatr Gastroenterol Nutr. 2016 Dec;63(6):637-643. doi: 10.1097/MPG.0000000000001177.
The respective role of disease activity and steroid therapy in growth impairment in paediatric-onset Crohn disease (CD) is still debated. Our aim was to investigate whether the growth pattern of children with CD was correlated with the inflammatory status during the disease course, regardless the cumulative duration of steroid therapy.
One hundred and seven patients with a diagnosis of CD <17 years, followed during ≥2 years and for whom ≥2 height measures were available during follow-up, were identified between 1998 and 2010. Height, C-reactive protein (CRP), orosomucoid, and steroid therapy duration were collected at each visit. The relationship between the evolution of growth velocity and inflammatory status during follow-up was investigated using a linear mixed model with random coefficients.
Median age at diagnosis was 11.7 years (Q1-Q3: 9.8-13.5). Mean height for age (H/A) z score was 0.14 ± 1.29 at diagnosis and 0.05 ± 1.23 among the 75 patients who had reached their final height at maximal follow-up (median: 4.9 years; Q1-Q3: 3.8-6.4). Growth failure (H/A z score <-2) was present in 7 (8%) patients at diagnosis and 5 (5%) at maximal follow-up. Growth velocity was negatively correlated with the evolution of CRP (P < 0.0001) and orosomucoid (P < 0.0001) during follow-up. After adjustment for the cumulative duration of steroid therapy, these 2 correlations remained significant (CRP: P = 0.0008; orosomucoid: P < 0.0001).
Children with CD with uncontrolled inflammatory status have a lower growth velocity. The inflammatory status should be kept as close to normal as possible in paediatric-onset patients with CD to optimize their growth pattern.
疾病活动和类固醇治疗在儿童期克罗恩病（CD）生长发育受损中各自的作用仍存在争议。我们的目的是研究CD患儿的生长模式是否与疾病过程中的炎症状态相关，而不考虑类固醇治疗的累计时长。
1998年至2010年间，确定了107例诊断为CD且年龄<17岁、随访≥2年且随访期间有≥2次身高测量数据的患者。每次就诊时收集身高、C反应蛋白（CRP）、血清类黏蛋白和类固醇治疗时长。使用具有随机系数的线性混合模型研究随访期间生长速度变化与炎症状态之间的关系。
诊断时的中位年龄为11.7岁（四分位间距：9.8 - 13.5岁）。诊断时年龄别身高（H/A）z评分平均为0.14 ± 1.29，在最大随访期达到最终身高的75例患者（中位值：4.9岁；四分位间距：3.8 - 6.4岁）中为0.05 ± 1.23。诊断时7例（8%）患者存在生长失败（H/A z评分<-2），最大随访期为5例（5%）。随访期间生长速度与CRP（P<0.0001）和血清类黏蛋白（P<0.0001）的变化呈负相关。在调整类固醇治疗的累计时长后，这两种相关性仍然显著（CRP：P = 0.0008；血清类黏蛋白：P<0.0001）。
炎症状态未得到控制的CD患儿生长速度较低。对于儿童期发病的CD患者，应尽可能使炎症状态接近正常，以优化其生长模式。
