Crescimento, desenvolvimento puberal e densidade mineral ossea em pacientes portadores de hepatite auto-imune na faixa etaria pediatrica




Autoimmune hepatitis (AIH) is a chronic inflammatory disease with unknown etiology; it causes a progressive destruction of the liver parenchyma, with progression to cirrhosis. Usually, the treatment is based in corticotherapy associated with Azathioprine. Among the side effects of the corticotherapy are osteoporosis, growth and development failure. Moreover, chronic liver diseases could cause metabolic bone disturbs, called hepatic osteodistrophy. The aim of this study was evaluate the corticotherapy effects and the liver disease effects on development, growth and bone mineral density (BMD) in pediatric patients with AIH. Were studied 17 patients of the hepatology s pediatric ambulatory in the Clinical Hospital ofMedical College ofUNICAMP. Were collected the following data: sex, birth date, diagnostic date, weight, height, dose of corticosteroid, parents height, puberal development. Corporal mass index, z score weightlage and height/age were established at the diagnosis and at the bone densitometry (BD) occasion. Bone age and BD were realized subsequent1y. The results of the BD were compared to chronological age (CA), height age (HA) and bone age (BA) and were compared with a control group matched by sex and chronological age. In witch BD analysis the patients were divided in 3 groups according to WHO classification. The results were related with corticosteroids dose, time of corticotherapy, time of use of high doses corticosteroids and to the Child-Pugh c1assification.The age ranged from 7 to 19 years, 6 (35,3%) males and 11 (64,7%) females. Only one (5,9%) patient had delay at bone age and height age but there was no puberal development delay. The initial z score height per age ranged from -1,49 to + 3,10 and the mean was 0,47 and the z score height per age at the time ofBD ranged from -2,19 to 2,38 and the mean was -0,03; being significative the difference. The frequency of the alterations on BD in the analysis with CA, HA, BA was 47%, 41,1% and 53% respectively. The BD results of the patients in comparison of the control were significant1y different. Conclusions:Growth disturbs were evident by the reduction of the z score height per age during the corticotherapy. There was an increase of body mass index during the corticotherapy. There was no interference on puberal development The BD was altered at about 50% of the patients. Bone disturbs had no correlation with corticosteroids doses and period of adrninistration. There was no relation within the results of BD and the pontuation ofthe Child-Pugh classification.


densidade ossea crianças - desenvolvimento hepatite auto-imune

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