Influence of inhaled corticosteroids on pubertal growth and final height in asthmatic children
Influence of inhaled corticosteroids on pubertal growth and final height in asthmatic children
复制标题
DOI：
10.1111/pai.12558
复制
发表时间：
2016-08-01
影响因子：
4.4
通讯作者：
Mohn, Angelika
中科院分区：
文献类型：
--
作者：
De Leonibus, Chiara;Attanasi, Marina;Mohn, Angelika
关于吸入性皮质类固醇（ICs）是否会影响轻度至中度哮喘儿童的生长，存在争议的数据。与对照组相比，我们评估了ic是否影响哮喘儿童的生长和最终身高（FH）。方法对113例哮喘患儿与66例对照组进行回顾性研究。哮喘患儿表现为轻度至中度哮喘，并有排他性ic。收集两组的四个特定时间点（青春期前、青春期开始和青春期晚期以及FH）的人体测量数据，并将其转换为标准差评分（SDS）。生长轨迹评估方法如下：(i)青春期，采用高峰身高速度（PHV）和青春期身高增长SDS (PHG-SDS)；（ii）直到跳频实现，使用跳频SDS和跳频增益SDS （FHG-SDS）。在纵向研究访问期间进行重复测量分析。在哮喘组采用一般线性模型（GLM）评估皮质类固醇类型、治疗时间和累积剂量对FH的影响，并对多个变量进行校正。结果两组儿童青春期前、身高、体重SDS差异无统计学意义（p < 0.05）。在研究期间，哮喘患者从青春期前到FH的身高SDS逐渐下降（p-trend < 0.05），而在对照组中，男孩和女孩的身高SDS没有随时间变化（p-trend >.05）。哮喘儿童的排他ICs[布地奈德（n = 36） vs氟替卡松（n = 43） vs莫米松（n = 34）]平均持续时间为6.25 ~ 1.20年，平均累积剂量为560.07±76.02 mg。与对照组相比，患者PHG-SDS降低，PHV降低（均p < 0.05）。哮喘组FH-SDS和FHG-SDS较对照组明显降低。哮喘患者的FH，男孩比对照组低2.5 +/- 2.89 cm，女孩比对照组低2.0 +/- 2.03 cm。GLM结果显示，FH效果与ic类型、治疗时间和累积剂量有关（p < 0.05）。结论与对照组相比，哮喘患儿最终身高降低与青春期生长有关，且呈剂量依赖性和持续依赖性。
BackgroundControversial data exist on the possibility that inhaled corticosteroids (ICs) affect growth in children with mild-to-moderate asthma. We assessed whether ICs affect growth and final height (FH) in asthmatic children compared to controls.MethodsA retrospective study was conducted on 113 asthmatic children compared with 66 control children. Asthmatic children presented with mild-to-moderate asthma and had exclusive ICs. Anthropometric data of four specific time-points were collected for both groups (pre-puberty, onset and late puberty, and FH) and converted to standard deviation scores (SDS). Growth trajectories were assessed as follows: (i) in puberty, using peak height velocity (PHV) and pubertal height gain SDS (PHG-SDS); (ii) until FH achievement, using FH-SDS and FH gain SDS (FHG-SDS). Repeated measurement analysis was performed across longitudinal study visits. A general linear model (GLM) was performed in asthmatic group evaluating the effect of corticosteroid type, treatment duration, and cumulative dose on FH corrected for multiple variables.ResultsAt pre-puberty, height and weight SDS were similar between the groups (p > 0.05). Height SDS progressively declined over the study period in asthmatic patients from pre-puberty to FH (p-trend < 0.05), whereas it did not change over time in controls (p-trend > 0.05), in both boys and girls. Asthmatic children had exclusive ICs [budesonide (n = 36) vs. fluticasone (n = 43) vs. mometasone (n = 34)] for a mean period of 6.25 1.20 years and a mean cumulative dose of 560.07 +/- 76.02 mg. They showed decreased PHG-SDS and lower PHV compared to controls (all p < 0.05). FH-SDS and FHG-SDS were significantly reduced in asthmatic group compared to controls. FH in asthmatic patients was 2.5 +/- 2.89 cm lower in boys and 2.0 +/- 2.03 cm lower in girls than controls. The GLM showed that FH achievement was dependent on the type of ICs, duration of the treatment, and cumulative dose (p < 0.05).ConclusionsICs affect pubertal growth determining reduced final height in asthmatic children compared to controls, in a dose- and duration-dependent manner.