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儿童肾移植后追赶性生长的临床特征
廖欣, 李颖杰, 谭锦兰, 张妙, 钟发展, 王长希, 邱江, 傅茜, 刘龙山, 高岩
中国当代儿科杂志 ›› 2020, Vol. 22 ›› Issue (7) : 755-761.
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儿童肾移植后追赶性生长的临床特征
Clinical features of catch-up growth after kidney transplantation in children
目的 探讨儿童肾移植后身高追赶性生长的临床特征及其影响因素。方法 回顾性分析2017年7月至2019年11月由广州市妇女儿童医疗中心提供并已接受肾移植手术的15例儿童受者的临床资料，根据肾移植后第1年身高标准差积分增值（△HtSDS）是否≥0.5分为追赶组（n=8）和无追赶组（n=7），根据末次身高标准差积分（HtSDS）是否≥-2分为达标组（n=6）和非达标组（n=9）。比较各组身高追赶性生长的特征和影响因素。结果 15例患儿移植后第1年中位△HtSDS为0.8，身高呈追赶性生长。追赶组与无追赶组间HtSDS差异有统计学意义（P < 0.05）。移植前基线HtSDS与随访终点HtSDS呈正相关（r=0.622，P < 0.05），与第1年△HtSDS呈负相关（r=-0.705，P < 0.05）。移植年龄和单位体重平均糖皮质激素（GC）剂量是肾移植后追赶性生长的危险因素（分别OR=1.23、1.74，均P < 0.05），基线HtSDS和降压药的使用是追赶性生长的独立保护因素（分别OR=0.08、0.18，均P < 0.05）；基线HtSDS和肾移植后第1年△HtSDS均为终点HtSDS的影响因素（分别β=0.984、1.271，均P < 0.05）。结论 拟行肾移植的患儿应尽早接受移植手术并尽可能改善移植前的生长落后；术后综合优化多项治疗措施如GC及降压药等的使用，有利于肾移植儿童受者达到最终的理想身高。
Objective To study the clinical features of catch-up growth of body height after kidney transplantation in children and related influencing factors. Methods A retrospective analysis was performed from the chart review data of 15 children who underwent kidney transplantation in Guangzhou Women and Children's Medical Center from July 2017 to November 2019. According to whether the increase in height standard deviation score (ΔHtSDS) in the first year after kidney transplantation reached ≥ 0.5, the children were divided into a catch-up group with 8 children and a non-catch-up group with 7 children. According to whether final HtSDS was ≥ -2, the children were divided into a standard group with 6 children and a non-standard group with 9 children. The features of catch-up growth of body height and related influencing factors were compared between groups. Results The data showed that median ΔHtSDS was 0.8 in the first year after transplantation, which suggested catch-up growth of body height. There was a significant difference in HtSDS between the non-catch-up and catch-up groups (P < 0.05). Baseline HtSDS before transplantation was positively correlated with HtSDS at the end of follow-up (r=0.622, P < 0.05) and was negatively correlated with △HtSDS in the first year after transplantation (r=-0.705, P < 0.05). Age of transplantation and mean dose of glucocorticoid (GC) per kg body weight were risk factors for catch-up growth after kidney transplantation (OR=1.23 and 1.74 respectively; P < 0.05), while baseline HtSDS and use of antihypertensive drugs were independent protective factors for catch-up growth (OR=0.08 and 0.18 respectively; P < 0.05); baseline HtSDS and ΔHtSDS in the first year after kidney transplantation were influencing factors for final HtSDS (β=0.984 and 1.271 respectively; P < 0.05). Conclusions Kidney transplantation should be performed for children as early as possible, growth retardation before transplantation should be improved as far as possible, and multiple treatment methods (including the use of GC and antihypertensive drugs) should be optimized after surgery, in order to help these children achieve an ideal body height.
Kidney transplantation / Body height / Catch-up growth / Child
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广州市科学技术局科学研究计划项目（201904010476）。
