Voss L D, Mulligan J, Betts P R
University Child Health, Southampton General Hospital, UK.
Child Care Health Dev. 1998 Mar;24(2):145-56. doi: 10.1046/j.1365-2214.1998.00051.x.
This study was carried out to examine the biological and environmental variables associated with non-organic short stature. We observed an unselected population of very short normal children (SN) and their age- and sex-matched controls (C) within the community. All 14,346 children in two health districts entering school during 2 consecutive years were screened for short stature, and those whose height lay below the 3rd centile, according to Tanner and Whitehouse standards (n = 180) were identified. Excluding 32 with pathology, five from ethnic minorities and three who refused to take part, the remaining SN children (mean height SDS-2.26) were matched with 140 age- and sex-matched controls (C) of average height (mean height SDs 0.14). Birth weight, target height and predicted adult height (based on parental height and bone age respectively), medical and social background (obtained from parental interviews), and school performance (assessed by class teachers) were the main outcome measures. Mean birth weight of the SN children was significantly lower than C (SN = 2845 g, C = 3337 g, P < 0.001). Mean mid-parental target height was also very different (SN = 162.0 cm, C = 170.9 cm, P < 0.001). Thirty-five per cent of SN children (C = 6%) had height SD scores below parental target range, though only 10% had predicted heights below target range (mean delay in bone age 0.68 years). There was a significant difference between SN children and C in the number of children in the household (SN = 2.8, C = 2.4 (P = 0.007) and in socio-economic status (P < 0.002). Many more SN children were in social classes IV and V (SN = 31%, C = 13%, P < 0.002), and had an unemployed father (SN = 22%, C = 10%, P < 0.010), highlighting the importance of environmental influences on growth. One in four SN children was judged to have serious psychosocial problems. However, the lower the socio-economic class, the less likely the SN children were to be inappropriately short for parents. Significantly more SN children were reported to have asthma (SN = 18%, C = 7%, P < 0.007) and eczema (SN = 19%, C = 5%, P < 0.001), though only the latter was significantly associated with stature below target height for both SN and C groups. Biological variables are often insufficient to explain short stature. No child, whatever the parental height, should be dismissed as normal without careful evaluation, as poor growth in the early years may be an important pointer to an adverse but potentially remediable environment.
本研究旨在探讨与非器质性身材矮小相关的生物学和环境变量。我们在社区中观察了一组未经挑选的身材非常矮小的正常儿童（SN）及其年龄和性别匹配的对照组（C）。对连续两年进入两个健康区学校的所有14346名儿童进行身材矮小筛查，根据坦纳和怀特豪斯标准，确定身高位于第3百分位数以下的儿童（n = 180）。排除32名患有疾病的儿童、5名少数民族儿童和3名拒绝参与的儿童后，其余SN儿童（平均身高标准差分数为 -2.26）与140名年龄和性别匹配、身高正常的对照组儿童（C，平均身高标准差分数为0.14）进行匹配。出生体重、目标身高和预测成年身高（分别基于父母身高和骨龄）、医学和社会背景（通过对父母的访谈获得）以及学校表现（由班级教师评估）是主要的观察指标。SN儿童的平均出生体重显著低于对照组（SN = 2845克，C = 3337克，P < 0.001）。父母平均目标身高也有很大差异（SN = 162.0厘米，C = 170.9厘米，P < 0.001）。35%的SN儿童（C组为6%）身高标准差分数低于父母目标范围，尽管只有10%的儿童预测身高低于目标范围（平均骨龄延迟0.68岁）。SN儿童和对照组在家庭子女数量（SN = 2.8，C = 2.4（P = 0.007））和社会经济地位（P < 0.002）方面存在显著差异。更多的SN儿童处于社会阶层IV和V（SN = 31%，C = 13%，P < 0.002），且父亲失业的情况更多（SN = 22%，C = 10%，P < 0.010），这突出了环境对生长影响的重要性。四分之一的SN儿童被判定存在严重的心理社会问题。然而，社会经济阶层越低，SN儿童因父母身高不匹配而身材过矮的可能性越小。据报告，显著更多的SN儿童患有哮喘（SN = 18%，C = 7%，P < 0.007）和湿疹（SN = 19%，C = 5%，P < 0.001），不过只有后者与SN组和C组低于目标身高的身材显著相关。生物学变量往往不足以解释身材矮小。无论父母身高如何，任何儿童在未经仔细评估之前都不应被视为正常，因为早年生长不良可能是不良但潜在可补救环境的重要指标。
