科研之友
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摘要
Background: Growth failure is well-recognized in pediatric inflammatory bowel disease (PIED; <18 years). We aimed to examine whether antitumor necrosis factor (TNF) therapy improves growth in a PIBD population-based cohort. Methods: A retrospective review of all Scottish children receiving anti-TNF (infliximab [IFX] and adalimumab [ADA]) from 2000 to 2012 was performed; height was collected at 12 months before anti-TNF (T-12), start (TO), and 12 (T+12) months after anti-TNF. Results: Ninety-three of 201 treated with IFX and 28 of 49 with ADA had satisfactory growth data; 66 had full pubertal data. Univariate analysis demonstrated early pubertal stages (Tanner 1-3 n = 44 vs T4-5 n=22), disease remission, disease duration >= 2 years, and duration of IFX >= 12 months were associated with improved linear growth for IFX; for ADA only improvement was seen in Tanner 1-3. For IFX, Tanner 1-3 median A standard deviation scores for height (Ht SDS) -0.3 (-0.7, 0.2) at T0 changed to 0.04 (-0.5, 0.7) at T+12 (P < 0.001) versus 0.01 (-0.5, 0.9) at T0 in T4-5 changed to 0.01 (-0.4, 0.2) at T+12 (P > 0.05). For IFX disease duration >= 2 year, median A Ht SDS was 0.13 (-0.6, 0.3) at T0 then 0.07 (-0.3, 0.6) at T+12 (P <0.001). Remission improved Delta Ht SDS (median Delta Ht SDS 0.14 [-0.6, 0.3] at T0 to 0.17 [-0.2, 0.7] at T+12 [P < 0.001]). Multiple regression analysis demonstrated corticosteroid usage at T0 predicted improved A Ht SDS at T+12 for IFX and ADA. Conclusions: Anti-TNF therapy is more likely to be associated with growth improvement when used at earlier stages of puberty with remission a key growth-promoting strategy in pediatric Crohn disease.
- 出版日期2017-1
