肾小球疾病患儿长期应用糖皮质激素导致身高增长障碍的影响因素分析

Influencing Factors of Growth Disorder Caused by Long-Term Use of Glucocorticoids in Pediatric Glomerular Disease

关键词:  肾小球疾病  儿童  糖皮质激素  不良反应  身高增长障碍

Key words:  glomerular disease  pediatric  glucocorticoid  adverse reactions  height growth disorder

摘要:

目的 明确肾小球疾病患儿长期糖皮质激素应用所致身高增长障碍的相关因素,探讨可能的原因及干预策略。方法 本研究回顾性收集于我院就诊的糖皮质激素连续使用至少6个月的肾小球疾病患儿资料,包括性别、身高、体重、激素类别、用法用量、起止时间、合用免疫抑制药物、诊断、起病年龄、复发情况等,并计算年平均身高增长(ΔH)。采用SPSS 软件进行单因素及多因素分析对ΔH有显著影响的因素。 结果 研究共纳入121例肾小球疾病患儿,人均使用糖皮质激素21.7个月,年均累积量按泼尼松计为159.5 mg/kg。激素起始及结束时的身高分别为112.8 ± 17.9、123.2 ± 15.6cm,年均ΔH为5.0 ± 1.7(0.0-10.4)cm。在结束时身高等级整体下降0.6 SD,并且1/4患儿身高低于同年龄性别2 SD,提示激素使用可导致身高增长障碍。进一步展开单因素及多因素分析后发现,起病年龄、年平均激素累积用量是影响ΔH的重要因素(呈显著负相关)。患儿起病年龄越大,年均ΔH越小,在3岁、7岁前起病者的年均ΔH分别为5.44、4.99cm。当患儿激素用量低于90 mg/kg/年(0.25mg/kg/天)时,年均ΔH约6.09cm,而超过274mg/kg/年(0.75mg/kg/天)时,年均ΔH仅为2.70cm。 结论 糖皮质激素长期使用对患儿身高增长的影响不容忽视,优化糖皮质激素治疗方案、联合使用免疫抑制剂、适时予以生长激素对症治疗,对于减少相关不良反应或有帮助。

Abstract:

OBJECTIVE To investigate the related factors of height growth disorder caused by long-term glucocorticoid use in children with glomerular disease, and to explore the possible causes and intervention strategies. METHODS Data of children with glomerular disease who were treated for continuously glucocorticoids for at least 6 months, were retrospectively collected, including gender, height, weight, glucocorticoids category, usage and dosage, starting and stopping time, combined use of immunosuppressive drugs, diagnosis, age of onset and recurrence. The average annual height increase (ΔH) was calculated. SPSS software was used to analyze the factors that have significant influence on ΔH. RESULTS A total of 121 children with glomerular disease were enrolled in this study. Glucocorticoids were used for 21.7 months, and the average annual cumulative dose was 159.5 mg/kg according to prednisone. The height at onset and end of the glucocorticoids were 112.8 ± 17.9 and 123.2 ± 15.6cm, respectively, and the average annual ΔH was 5.0 ± 1.7 (0.0-10.4) cm. There was an overall decrease of 0.6 SD in height grade at the end, and a quarter of the children were 2 SD shorter than the same age sex. Further univariate analysis and multivariate analysis showed that, age of onset and average annual glucocorticoids cumulative dose were important factors influencing ΔH (with significant negative correlation). The older the age of onset, the smaller the annual ΔH was. When the glucocorticoids dosage was less than 90 mg/kg/ year (0.25mg/kg/ day), ΔH was about 6.09cm, and when the glucocorticoids dosage was more than 274mg/kg/ year (0.75mg/kg/ day), ΔH was only 2.70cm. CONCLUSION The effect of long-term use of glucocorticoids on the height growth of children should not be ignored. Optimization of glucocorticoid therapy, combined use of immunosuppressants, and timely symptomatic treatment of growth hormone may be helpful to reduce the related adverse reactions.