青少年炎症性肠病伴生长激素缺乏4例并文献复习

Inflammatory bowel disease with growth hormone deficiency in adolescents: an analysis of 4 cases and literature review

摘要:

炎症性肠病（IBD）为慢性复发性非特异性肠道炎症性病变，10%~56%的克罗恩病患儿和10%左右的溃疡性结肠炎患儿存在生长迟缓。该研究报道4例伴生长激素缺乏的青少年IBD（均为克罗恩病），其中男3例、女1例，确诊年龄11.0~13.9岁，确诊时病程11~85个月。4例患儿的病灶分别为：单纯小肠、单纯结肠、小肠及上消化道、小肠及结肠均累及，克罗恩病活动指数27.5~45分。4例患儿的年龄别身高Z评分（HAZ）均 < -2，生长激素刺激试验均提示生长激素缺乏症。2例患儿接受了重组人生长激素联合英夫利西单抗治疗，1例仅接受英夫利西单抗治疗，另1例接受重组人生长激素联合巯嘌呤的治疗。所有患儿经治疗后HAZ评分均有改善。

Abstract:

Inflammatory bowel disease (IBD) is a chronic recurrent non-specific inflammatory disease in the intestinal tract. About 10%-56% of children with Crohn's disease and about 10% of children with ulcerative colitis have growth retardation. This study reports four adolescents with IBD and growth hormone deficiency who were diagnosed with Crohn's disease. There were three boys and one girl, with an age of 11.0-13.9 years and a disease duration of 11-85 months at diagnosis. The four patients had the involvement of the small intestine only, the colon only, both the small intestine and the upper gastrointestinal tract, and both the small intestine and the colon respectively. The pediatric Crohn's disease activity index ranged from 27.5 to 45 points. All four patients had a height-for-age Z-score (HAZ) of < -2, and the growth hormone provocative test suggested growth hormone deficiency. Of all four patients, two received recombinant human growth hormone combined with infliximab, one received infliximab only, and one received recombinant human growth hormone combined with mercaptopurine. All four patients had an improvement in HAZ after treatment.