Bamberger Sarah, Martinez Vinson Christine, Mohamed Damir, Viala Jérôme, Carel Jean-Claude, Hugot Jean-Pierre, Simon Dominique
Service de Gastroentérologie Pédiatrique, Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France.
Unité d'Epidémiologie Clinique, Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France.
PLoS One. 2016 Sep 16;11(9):e0163126. doi: 10.1371/journal.pone.0163126. eCollection 2016.
Inflammation contributes to growth failure associated with inflammatory bowel diseases. Anti-TNFα therapy induces sustained remission and short-term improvements in height velocity and/or height standard deviation score (H-SDS) patients with Crohn's disease. The purpose of this study was to evaluate growth and adult height in patients with Crohn's disease taking maintenance infliximab or adalimumab therapy.This university-hospital based retrospective study included 61 patients, with a median follow-up of 2.6 years (2.0; 3.3). 38 patients (62%) reached their adult height. H-SDS was collected at diagnosis and together with disease activity markers (Harvey-Bradshaw Index, albumin, and C-reactive protein) at treatment initiation (baseline), and follow-up completion. Wilcoxon's signed-rank test was chosen for comparisons. Median H-SDS decreased from diagnosis to baseline (-0.08 [-0.73; +0.77] to -0.94 [-1.44; +0.11], p<0.0001) and then increased to follow-up completion (-0.63 [-1.08; 0.49], p = 0.003 versus baseline), concomitantly with an improvement in disease activity. Median adult H-SDS was within the normal range (-0.72 [-1.25; +0.42]) but did not differ from baseline H-SDS and was significantly lower than the target H-SDS (-0.09 [-0.67; +0.42], p = 0.01). Only 2 (6%) males had adult heights significantly below their target heights (10.5 and -13.5 cm [-1.75 and -2.25 SD]). In conclusion, anti-tumor necrosis factor α (TNF) therapy prevented loss of height without fully restoring the genetic growth potential in this group of patients with CD. Earlier treatment initiation might improve growth outcomes in these patients.
炎症会导致与炎症性肠病相关的生长发育迟缓。抗TNFα治疗可使克罗恩病患者实现持续缓解，并在短期内改善身高增长速度和/或身高标准差评分（H-SDS）。本研究旨在评估接受英夫利昔单抗或阿达木单抗维持治疗的克罗恩病患者的生长发育情况及成年身高。这项基于大学医院的回顾性研究纳入了61例患者，中位随访时间为2.6年（2.0；3.3）。38例患者（62%）达到了成年身高。在诊断时收集H-SDS，并在治疗开始时（基线）和随访结束时，与疾病活动指标（哈维-布拉德肖指数、白蛋白和C反应蛋白）一起收集。选择Wilcoxon符号秩检验进行比较。H-SDS中位数从诊断时到基线时下降（从-0.08[-0.73；+0.77]降至-0.94[-1.44；+0.11]，p<0.0001），然后在随访结束时升高（-0.63[-1.08；0.49]，与基线相比p = 0.003），同时疾病活动得到改善。成年H-SDS中位数在正常范围内（-0.72[-1.25；+0.42]），但与基线H-SDS无差异，且显著低于目标H-SDS（-0.09[-0.67；+0.42]，p = 0.01）。只有2例（6%）男性的成年身高显著低于其目标身高（分别低10.5厘米和13.5厘米[-1.75和-2.25标准差]）。总之，抗肿瘤坏死因子α（TNF）治疗可防止该组克罗恩病患者身高丢失，但未能完全恢复其遗传生长潜力。更早开始治疗可能会改善这些患者的生长结局。
