Abdalla Eiman, Jeyaseelan Lakshamanan, Ullah Irfan, Abdwani Reem
Pediatric Rheumatology Division, Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
Statistics Department, Sultan Qaboos University Hospital, Muscat, Oman.
Oman Med J. 2017 Jul;32(4):284-290. doi: 10.5001/omj.2017.56.
Children with childhood-onset systemic lupus erythematosus (cSLE) enter adulthood with considerable morbidity. Of the recognized morbidities, growth failure is unique to cSLE. The aim of this study was to evaluate the growth pattern in children with cSLE longitudinally and identify possible risk factors.
Serial anthropometric measurements of cSLE patients were obtained over two years and expressed as z-scores. Parental heights were obtained to calculate target height. Parent-adjusted height z-score was calculated as the difference between height z-score and target height. Growth failure was defined as parent-adjusted height z-score -1.50. Risk factors that might have contributed to growth failure were evaluated including the presence of growth failure at baseline, disease activity, disease duration, and cumulative steroid doses.
Twenty-five patients were included in the study. Growth failure was observed in eight patients with an overall incidence of 32.0% (95% confidence interval (CI): 14-50%). When comparing the cohort with and without growth failure, the factors that determined growth failure was the pre-existence of growth failure at the time of diagnosis (z-score < -1.95 vs. 0.35; < 0.001); higher cumulative steroid dose (15.8 vs. 9.1 g ; 0.061); and tendency for longer disease duration (5.4 vs. 3.7 years; 0.240). However, the severity of disease activity at the time of diagnosis was not a significant contributing factor (12 vs. 14; = 0.529).
Children with cSLE are at risk of having a negative effect on height including patients with pre-existing growth failure, high cumulative steroid dose, and longer disease duration. However, longitudinal prospective studies are needed to examine damage over time to improve health-related quality of life.
儿童期起病的系统性红斑狼疮（cSLE）患儿成年后存在相当高的发病率。在已确认的发病情况中，生长发育迟缓是cSLE所特有的。本研究的目的是纵向评估cSLE患儿的生长模式，并确定可能的风险因素。
在两年时间内对cSLE患者进行系列人体测量，并以z评分表示。获取父母的身高以计算靶身高。父母调整后的身高z评分计算为身高z评分与靶身高之间的差值。生长发育迟缓定义为父母调整后的身高z评分＜-1.50。评估可能导致生长发育迟缓的风险因素，包括基线时是否存在生长发育迟缓、疾病活动度、病程和累积类固醇剂量。
25例患者纳入本研究。8例患者出现生长发育迟缓，总体发生率为32.0%（95%置信区间（CI）：14-50%）。在比较有和没有生长发育迟缓的队列时，决定生长发育迟缓的因素是诊断时预先存在生长发育迟缓（z评分＜-1.95对0.35；P＜0.001）；累积类固醇剂量较高（15.8对9.1g；P = 0.061）；以及病程较长的趋势（5.4对3.7年；P = 0.240）。然而，诊断时疾病活动度的严重程度不是一个显著的影响因素（12对14；P = 0.529）。
cSLE患儿存在身高受负面影响的风险，包括预先存在生长发育迟缓、累积类固醇剂量高和病程长的患者。然而，需要进行纵向前瞻性研究以检查随时间的损害情况，以改善与健康相关的生活质量。
