Motil K J, Grand R J, Davis-Kraft L, Ferlic L L, Smith E O
United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Houston, Texas.
Gastroenterology. 1993 Sep;105(3):681-91. doi: 10.1016/0016-5085(93)90883-e.
Growth failure frequently complicates the clinical course of inflammatory bowel disease (IBD) in children. This study was designed to investigate the role of disease activity versus steroid therapy on growth faltering in this disorder.
We studied growth failure and its relationship to disease activity and steroid therapy in 69 children who have IBD by prospectively monitoring height for a maximum of 3 years. Disease activity and steroid use were recorded at entry into the study.
The prevalence of growth failure was 24%, 23%, and 39% by height velocity, Z score, and height-for-age criteria, respectively; deficits were equally prevalent regardless of the stage of pubertal development. A delay in linear growth persisted throughout puberty and was not reversed after surgery. Patients who had Crohn's disease were twice as likely to have growth abnormalities than patients who had ulcerative colitis. We detected significant negative associations between linear growth and disease activity but not steroid therapy.
In a unique group of children, growth failure is an early, "prepatterned" manifestation of IBD. The inflammatory process, rather than steroid use, has a predominant influence on the development of growth faltering.
生长发育迟缓常使儿童炎症性肠病（IBD）的临床病程复杂化。本研究旨在探讨疾病活动度与类固醇治疗对该疾病生长发育迟缓的作用。
我们通过前瞻性监测69例IBD患儿的身高，最长监测3年，研究生长发育迟缓及其与疾病活动度和类固醇治疗的关系。研究开始时记录疾病活动度和类固醇使用情况。
根据身高增长速度、Z评分和年龄别身高标准，生长发育迟缓的患病率分别为24%、23%和39%；无论青春期发育阶段如何，生长发育迟缓的发生率相同。整个青春期线性生长延迟持续存在，手术后也未逆转。患有克罗恩病的患者出现生长异常的可能性是患有溃疡性结肠炎患者的两倍。我们检测到线性生长与疾病活动度之间存在显著负相关，但与类固醇治疗无关。
在一组独特的儿童中，生长发育迟缓是IBD的早期“预成型”表现。炎症过程而非类固醇的使用对生长发育迟缓的发生起主要影响。
