Griffiths A M, Nguyen P, Smith C, MacMillan J H, Sherman P M
Division of Gastroenterology, Hospital for Sick Children, Toronto, Ontario, Canada.
Gut. 1993 Jul;34(7):939-43. doi: 10.1136/gut.34.7.939.
Growth impairment is a common complication of childhood Crohn's disease, but longitudinal data and follow up studies into adulthood are sparse. This study reviewed the records of 100 Tanner stages 1 and 2 children (66 males, 34 females) consecutively diagnosed with Crohn's disease at this hospital between January 1980 and June 1988. The influence of sex, anatomical location of disease, severity of symptoms, corticosteroids, and surgical intervention on growth were analysed by univariate and multivariate regression analysis. At diagnosis mean standard deviation score (SDS) for height was -1.11 (1.28) (males -1.14 (1.26), females -1.05 (1.33)). Twenty one children were below the third centile for height. During years one and two height velocity (cm/y) was 4.4 (2.3) and 5.1 (2.7), but 40% of children in year one and 33% of children in year two grew less than expected (< 4 cm). Forty nine children grew < 4 cm/y during two or more of the 4.9 (1.8) years of follow up. Severity of gastrointestinal symptoms was the major factor influencing linear growth velocity (p < 0.01 for years one and two). Despite the high prevalence of growth impairment, the subset of children who had reached maturity by the time of the study (n = 67) nevertheless maintained their height centile. The SDS for height at ultimate follow up was -0.82 (1.1). Compared with diagnosis, change in SDS was +0.35 (1.08). Growth increments were comparable for surgically treated patients v patients only treated medically and among patients stratified by location of disease. Females (n = 25) achieved greater catch up growth than males (n = 42). Ultimate SDS for height for females was -0.48 (0.91) v -1.02 (1.19) for males. Change in SDS for height was +0.66 (1.27) for females v +0.16 (0.90) for males (p=0.02). These data confirm the frequency of growth impairment in childhood Crohn's disease. After diagnosis, however, the prognosis for ultimate linear growth is good.
生长发育迟缓是儿童克罗恩病的常见并发症，但纵向数据以及成年后的随访研究较为匮乏。本研究回顾了1980年1月至1988年6月期间在本院连续诊断为克罗恩病的100名坦纳1期和2期儿童（66名男性，34名女性）的病历。通过单变量和多变量回归分析，分析了性别、疾病的解剖位置、症状严重程度、皮质类固醇和手术干预对生长发育的影响。诊断时身高的平均标准差评分（SDS）为-1.11（1.28）（男性为-1.14（1.26），女性为-1.05（1.33））。21名儿童身高低于第三百分位数。在第1年和第2年，身高增长速度（厘米/年）分别为4.4（2.3）和5.1（2.7），但第1年40%的儿童和第2年33%的儿童生长低于预期（<4厘米）。在4.9（1.8）年的随访期间，49名儿童有两年或更长时间生长<4厘米/年。胃肠道症状的严重程度是影响线性生长速度的主要因素（第1年和第2年p<0.01）。尽管生长发育迟缓的患病率很高，但在研究时已达到成熟的儿童亚组（n = 67）仍保持其身高百分位数。最终随访时身高的SDS为-0.82（1.1）。与诊断时相比，SDS的变化为+0.35（1.08）。手术治疗患者与仅接受药物治疗的患者以及按疾病部位分层的患者之间的生长增量相当。女性（n = 25）比男性（n = 42）实现了更大的追赶生长。女性身高的最终SDS为-0.48（0.91），男性为-1.02（1.19）。女性身高SDS的变化为+0.66（1.27），男性为+0.16（0.90）（p = 0.02）。这些数据证实了儿童克罗恩病中生长发育迟缓的发生率。然而，诊断后，最终线性生长的预后良好。
