Patterson Catherine, So Stephanie, Rogers Alaine, Ng Vicky L
Rehabilitation Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Transplant and Regenerative Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Transplant. 2022 May;26(3):e14200. doi: 10.1111/petr.14200. Epub 2021 Dec 7.
Motor skill acquisition plays an important role in physical activity participation and overall social and physical health. Limited studies have examined motor development in children pre-and post-liver transplant (LT).
Retrospective review of motor outcomes in children <6 years old with cholestatic liver disease assessed pre-and 1-year post-isolated LT. Measures include Alberta Infant Motor Scale and Peabody Developmental Motor Scales (gross motor quotient (GMQ), fine motor quotient (FMQ), and total motor quotient (TMQ)). Association of medical variables with motor outcomes was explored.
Participants included 33 (58% male) children with diagnoses of biliary atresia (70%), Alagille syndrome (21%), and others (9%). Median age at LT was 10 (IQR 7.0-20.5) months. Pre-LT >75% of children were at risk for motor delay (≤10 percentile on AIMS/ ≥1SD below mean GMQ). Post-LT, 52% scored ≥1 SD below the mean GMQ compared with 22% FMQ. Children at risk/delayed pre-LT had an increased risk of motor delay on GMQ post-LT (odds ratio 11.43, 95% CI 1.12-116.7, p = .017). Higher INR pre-LT correlated with lower TMQ post-LT (r = -.51, p = .003). Longer waitlist time correlated with lower FMQ post-LT (r = .41, p = .03). GMQ post-LT and height z-scores pre-LT (r = .46, p = .02) and post-LT (r = .45, p < .01) were positively correlated. There was no correlation with presence of ascites, weight z-score, length of hospitalization, and age at LT.
Young children have increased risk of motor delay pre-LT, which may persist post-LT. Severity of liver disease and growth delays may impact motor development, highlighting the need for ongoing rehabilitation pre- and post-LT.
运动技能的获得在身体活动参与以及整体社会和身体健康方面起着重要作用。仅有有限的研究考察了肝移植（LT）前后儿童的运动发育情况。
对6岁以下胆汁淤积性肝病儿童在孤立性肝移植术前及术后1年的运动结局进行回顾性分析。测量指标包括艾伯塔婴儿运动量表和皮博迪发育运动量表（粗大运动商数（GMQ）、精细运动商数（FMQ）和总运动商数（TMQ））。探讨了医学变量与运动结局之间的关联。
参与者包括33名儿童（58%为男性），诊断为胆道闭锁（70%）、阿拉吉列综合征（21%）和其他疾病（9%）。肝移植时的中位年龄为10（四分位间距7.0 - 20.5）个月。肝移植术前，超过75%的儿童存在运动发育迟缓风险（艾伯塔婴儿运动量表得分≤第10百分位/粗大运动商数低于均值≥1个标准差）。肝移植术后，52%的儿童粗大运动商数得分低于均值≥1个标准差，精细运动商数方面为22%。肝移植术前有风险/发育迟缓的儿童在肝移植术后粗大运动商数出现运动发育迟缓的风险增加（比值比11.43，95%置信区间1.12 - 116.7，p = 0.017）。肝移植术前较高的国际标准化比值与肝移植术后较低的总运动商数相关（r = -0.51，p = 0.003）。等待名单时间较长与肝移植术后较低的精细运动商数相关（r = 0.41，p = 0.03）。肝移植术后粗大运动商数与肝移植术前身高z评分（r = 0.46，p = 0.02）和术后身高z评分（r = 0.45，p < 0.01）呈正相关。与腹水的存在、体重z评分、住院时间和肝移植时的年龄无关。
幼儿在肝移植术前运动发育迟缓风险增加，这可能在肝移植术后持续存在。肝脏疾病的严重程度和生长发育迟缓可能影响运动发育，突出了肝移植前后持续进行康复治疗的必要性。
