Thiopurines are negatively associated with anthropometric parameters in pediatric Crohn's disease  

作　　者：Neera Gupta Robert H Lustig Cewin Chao Eric Vittinghoff Howard Andrews Cheng-Shiun Leu 

机构地区：[1]Division of Gastroenterology and Nutrition, Department of Pediatrics, Weill Cornell Medicine [2]Division of Endocrinology, Department of Pediatrics, University of California,San Francisco [3]Department of Nutrition and Food Services, University of California,San Francisco [4]Department of Epidemiology and Biostatistics, University of California,San Francisco [5]Department of Biostatistics, Mailman School of Public Health, Columbia University [6]Department of Biostatistics, Columbia University Medical Center

出　　处：《World Journal of Gastroenterology》2018年第18期2036-2046,共11页世界胃肠病学杂志（英文版）

基　　金：Supported by National Institutes of Health,No.DK077734(NG);Children’s Digestive Health and Nutrition Foundation(now known as North American Society for Pediatric Gastroenterology,Hepatology,and Nutrition Foundation)/Crohn’s and Colitis Foundation of America(now known as Crohn’s and Colitis Foundation)Award for New Investigators,No.CDHNF-06-002(NG);Crohn’s and Colitis Foundation of America(now known as Crohn’s and Colitis Foundation)Career Development Award,No.Award ID 1743(NG);University of California San Francisco Department of Pediatrics Pediatric Clinical Research Center Clinical Research Pilot Funding Award(NG);National Institutes of Health/National Center for Research Resources University of California San Francisco-Clinical and Translational Science Institute,No.UL1 RR024131

摘　　要：AIM To determine the distribution of anthropometric parameter(AP)-z-scores and characterize associations between medications/serum biomarkers and AP-z-scores in pediatric Crohn's disease(CD).METHODS CD patients [< chronological age(CA) 21 years] were enrolled in a cross-sectional study. Descriptive statistics were generated for participants' demographic characteristics and key variables of interest. Paired t-tests were used to compare AP-z-scores calculated based on CA(CA z-scores) and bone age(BA)(BA z-scores) for interpretation of AP's. Linear regression was utilized to examine associations between medications and serum biomarkers with AP-z-scores calculated based on CA(n = 82) and BA(n = 49). We reported regression coefficients as well as their corresponding p-values and 95% confidence intervals.RESULTS Mean CA at the time of the study visit was 15.3 ± 3.5(SD; range = 4.8-20.7) years. Mean triceps skinfold(P = 0.039), subscapular skinfold(P = 0.002) and midarm circumference(MAC)(P = 0.001) BA z-scores were higher than corresponding CA z-scores. Medications were positively associated with subscapular skinfold [adalimumab(P = 0.018) and methotrexate(P = 0.027)] and BMI CA z-scores [adalimumab(P = 0.029)]. Azathioprine/6-mercaptopurine were negatively associated with MAC(P = 0.045), subscapular skinfold(P = 0.014), weight(P = 0.002) and BMI(P = 0.013) CA z-scores. ESR, CRP, and WBC count were negatively associated, while albumin and IGF-1 BA z-scores were positively associated, with specific AP z-scores(P < 0.05). Mean height CA z-scores were higher in females, not males, treated with infliximab(P = 0.038). Hemoglobin(P = 0.018) was positively associated, while platelets(P = 0.005), ESR(P = 0.003) and CRP(P = 0.039) were negatively associated with height CA z-scores in males, not females. CONCLUSION Our results suggest poor efficacy of thiopurines and a possible sex difference in statural growth response to infliximab in pediatric CD. Prospective longitudinal studies are required.AIM To determine the distribution of anthropometric parameter(AP)-z-scores and characterize associations between medications/serum biomarkers and AP-z-scores in pediatric Crohn's disease(CD).METHODS CD patients [< chronological age(CA) 21 years] were enrolled in a cross-sectional study. Descriptive statistics were generated for participants' demographic characteristics and key variables of interest. Paired t-tests were used to compare AP-z-scores calculated based on CA(CA z-scores) and bone age(BA)(BA z-scores) for interpretation of AP's. Linear regression was utilized to examine associations between medications and serum biomarkers with AP-z-scores calculated based on CA(n = 82) and BA(n = 49). We reported regression coefficients as well as their corresponding p-values and 95% confidence intervals.RESULTS Mean CA at the time of the study visit was 15.3 ± 3.5(SD; range = 4.8-20.7) years. Mean triceps skinfold(P = 0.039), subscapular skinfold(P = 0.002) and midarm circumference(MAC)(P = 0.001) BA z-scores were higher than corresponding CA z-scores. Medications were positively associated with subscapular skinfold [adalimumab(P = 0.018) and methotrexate(P = 0.027)] and BMI CA z-scores [adalimumab(P = 0.029)]. Azathioprine/6-mercaptopurine were negatively associated with MAC(P = 0.045), subscapular skinfold(P = 0.014), weight(P = 0.002) and BMI(P = 0.013) CA z-scores. ESR, CRP, and WBC count were negatively associated, while albumin and IGF-1 BA z-scores were positively associated, with specific AP z-scores(P < 0.05). Mean height CA z-scores were higher in females, not males, treated with infliximab(P = 0.038). Hemoglobin(P = 0.018) was positively associated, while platelets(P = 0.005), ESR(P = 0.003) and CRP(P = 0.039) were negatively associated with height CA z-scores in males, not females. CONCLUSION Our results suggest poor efficacy of thiopurines and a possible sex difference in statural growth response to infliximab in pediatric CD. Prospective longitudinal studies are required.

关 键 词：Inflammatory BOWEL disease Azathioprine/6-mercaptopurine BIOLOGICS Nutrition 

分 类 号：R725.7[医药卫生—儿科]