Markowitz J, Grancher K, Rosa J, Aiges H, Daum F
Department of Pediatrics, North Shore University Hospital, Manhasset, NY 11030.
J Pediatr Gastroenterol Nutr. 1993 May;16(4):373-80. doi: 10.1097/00005176-199305000-00005.
To assess whether children with inflammatory bowel disease (IBD) develop permanent impairment of linear growth, we analyzed records from 48 young adults who had IBD during childhood or early adolescence (Tanner I-III; 11.8 +/- 2.4 years old at diagnosis). All were fully grown (Tanner V; 21.1 +/- 3.0 years) at last examination. Adult heights were predicted from data obtained at or shortly after the diagnosis of IBD by three methods: height for age percentile, the Bailey-Pinneau (BP), and Roche-Wainer-Thissen (RWT) methods. Predicted adult heights were then compared with the actual ultimate height of each subject. Permanent growth failure occurred in 19-35% of subjects, depending upon the method used to assess growth. Overall, 31% (15 of 48) of the subjects had deficits of adult height identified by two or more methods, including 14 of 38 (37%) of those with Crohn's disease but only one of 10 with ulcerative colitis. Age at diagnosis of IBD, age at last examination, age at cessation of linear growth, and site of IBD did not differ between impaired and normal growth groups. Duration of corticosteroid use was longer (p < 0.05) in growth-impaired subjects. In addition, although 60% of all subjects had periods of poor growth that put them in height-for-age percentiles two or more major growth channels below previous percentiles, only 19% remained at these levels upon achieving their final adult heights. Permanent impairment of linear growth leading to clinically meaningful deficits of ultimate adult height is common in patients with IBD in childhood or early adolescence. New therapeutic approaches are needed to address this problem.
为评估炎症性肠病（IBD）患儿是否会出现线性生长的永久性损害，我们分析了48名在儿童期或青春期早期患有IBD的年轻成年人（ Tanner I - III期；诊断时年龄为11.8±2.4岁）的记录。在最后一次检查时，所有患者均已成年（ Tanner V期；年龄为21.1±3.0岁）。通过三种方法根据IBD诊断时或诊断后不久获得的数据预测成年身高：年龄别身高百分位数法、贝利-平诺（BP）法和罗氏-韦纳-蒂森（RWT）法。然后将预测的成年身高与每个受试者的实际最终身高进行比较。根据评估生长的方法不同，19% - 35%的受试者出现永久性生长失败。总体而言，31%（48名中的15名）受试者的成年身高不足通过两种或更多方法得以确定，其中克罗恩病患者中有38名中的14名（37%），而溃疡性结肠炎患者中10名仅有1名。生长受损组和正常生长组在IBD诊断年龄、最后检查年龄、线性生长停止年龄以及IBD病变部位方面并无差异。生长受损的受试者使用皮质类固醇的时间更长（p < 0.05）。此外，尽管所有受试者中有60%曾有生长缓慢阶段，使其年龄别身高百分位数比之前的百分位数低两个或更多主要生长通道，但在达到最终成年身高时，只有19%的人仍处于这些水平。儿童期或青春期早期患有IBD的患者中，导致最终成年身高出现具有临床意义不足的线性生长永久性损害很常见。需要新的治疗方法来解决这一问题。
