糖皮质激素治疗对细支气管炎患儿长期生长发育的影响

Effect of glucocorticoid therapy on long-term growth and development of children with bronchiolitis

摘要:

目的 探究糖皮质激素治疗对细支气管炎患儿生长发育的影响。 方法 回顾性选取2017年2月至2018年3月经糖皮质激素治疗的细支气管炎患儿143例为研究对象。收集患儿初次入院时身高、体重、病程、诊疗方案等病史资料。在治疗3年后测量患儿体格发育指标，并对患儿生长发育情况进行Z评分；同时检测患儿骨钙素、血清磷、胰岛素样生长因子1等指标水平。 结果 细支气管炎患儿经糖皮质激素治疗3年后的生长迟缓和肥胖的比例均高于治疗前（P<0.05）；糖皮质激素使用时间≥29 d患儿肥胖比例高于<29 d（P<0.05）；治疗期间是否雾化对患儿生长发育情况无影响（P>0.05）。相较于生长发育迟缓患儿，发育正常患儿的血清磷和胰岛素样生长因子-1水平均较高（P<0.05）。 结论 使用糖皮质激素治疗细支气管炎患儿会对其长期生长发育造成不良影响。

Abstract:

Objective To explore the effect of glucocorticoid therapy on the growth and development of children with bronchiolitis. Methods A total of 143 children with bronchiolitis who were treated with glucocorticoids from February 2017 to March 2018 were enrolled. The medical data were retrospectively collected, including height, weight, course of the disease, and diagnosis and treatment plan at initial admission. After three years of treatment, physical development indices were measured, growth and development were evaluated by Z-score, and related hematological parameters were measured, including osteocalcin, serum phosphorus, and insulin-like growth factor-1. Results As for the children with bronchiolitis, the incidence rates of growth retardation and obesity increased significantly after three years of glucocorticoid therapy (P<0.05). The children treated with glucocorticoids for ≥29 days showed a significantly higher incidence rate of obesity than those treated with glucocorticoids for <29 days (P<0.05), while nebulized glucocorticoid treatment had no effect on the growth and development (P>0.05). Compared with the children with growth retardation, the children with normal development had significantly higher levels of serum phosphorus and insulin-like growth factor-1 (P<0.05). Conclusions Glucocorticoid therapy can adversely affect long-term growth and development in children with bronchiolitis.