Linear Growth Patterns in Prepubertal Children Following Liver Transplantation
Linear Growth Patterns in Prepubertal Children Following Liver Transplantation
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DOI：
10.1111/j.1600-6143.2009.02634.x
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发表时间：
2009-06-01
影响因子：
8.8
通讯作者：
Anand, R.
中科院分区：
文献类型：
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作者：
Alonso, E. M.;Shepherd, R.;Anand, R.
影响小儿肝移植（LT）后线性生长的因素尚不清楚。这项纵向分析检查了儿科肝移植研究中青春期前儿童线性生长障碍的预测因素。在进行连续测量的 1143 名儿童中，平均身高得分从 LT 时的 -1.55 增加到 LT 后 24 个月和 36 个月时的 -0.87 和 -0.68，并且在 60 个月之前观察到随后的追赶性生长极小。对 24 个月时身高测量值进行亚组分析 (n = 696)，LT 后 24 个月时，33.8% 的身高低于第 10 个百分位数。多变量分析显示，患有代谢性疾病（OR 4.4，CI：1.83-10.59）和类固醇暴露> 18个月（OR 3.02，CI：1.39-6.55）的患者更可能出现线性生长障碍。 LT 时体重（OR 0.80，CI：0.65-0.99）和身高（OR 0.62，CI：0.51-0.77）较高的百分位可降低风险。在 LT 之前患有代谢性疾病、非胆道闭锁胆汁淤积性疾病以及体重较低和身高百分位数较高的患者中观察到线性追赶较少。 LT 后长时间的类固醇暴露以及计算的肾小球滤过率和γ-谷氨酰转移酶升高与追赶生长较少有关。线性生长障碍和不完全线性追赶性生长在 LT 后很常见，可以通过避免 LT 前的晚期生长障碍和尽量减少类固醇暴露来改善。
Factors impacting linear growth following pediatric liver transplantation (LT) are not well understood. This longitudinal analysis examines predictors of linear growth impairment in prepubertal children included in Studies of Pediatric Liver Transplantation. In 1143 children with serial measurements, mean height scores increased from -1.55 at LT to -0.87 and -0.68 at 24 and 36 months post LT with minimal subsequent catch up growth observed until 60 months. Subgroup analysis of height measurements at 24 months (n = 696), 33.8% were below 10th percentile at 24 months post LT. Multivariate analysis revealed linear growth impairment more likely in patients with metabolic disease (OR 4.4, CI: 1.83-10.59) and > 18 months of steroids exposure (OR 3.02, CI: 1.39-6.55). Higher percentiles for weight (OR 0.80, CI: 0.65-0.99) and height (OR 0.62, CI: 0.51-0.77) at LT decreased risk. Less linear catch up was observed in patients with metabolic disease, non-Biliary atresia cholestatic diseases and lower weight and higher height percentiles prior to LT. Prolonged steroid exposure and elevated calculated glomerular filtration rate and gamma-Glutamyltransferase following LT were associated with less catch up growth. Linear growth impairment and incomplete linear catch up growth are common following LT and may improve by avoiding advanced growth failure before LT and steroid exposure minimization.