沙特脑性瘫痪儿童的人体测量学结局：与粗大运动严重程度及进食饮水能力的关联

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中文摘要

背景： 生长迟缓是脑性瘫痪（CP）常见且具有临床意义的并发症，但采用标准化人体测量学结局的区域人群数据仍然有限。
目的： 使用WHO年龄和性别标准化的z评分量化人体测量学缺陷，并在一个沙特CP儿童临床队列中识别独立预测因素。
方法： 对107名沙特CP儿童（中位年龄4.3岁，IQR 2.4-6.2；68.2%为男性）进行回顾性横断面研究。人体测量学结局采用WHO 2006/2007参考标准表示为年龄别体重（WAZ）、年龄别身高（HAZ）、年龄别BMI（BAZ）和年龄别头围（HCAZ）z评分。组间比较采用Mann-Whitney U检验和Kruskal-Wallis检验，并计算效应量（秩双列相关；epsilon平方）。使用七个先验预测因素拟合四个多变量线性回归模型：年龄、性别、GMFCS水平（IV-V vs I-III）、进食饮水能力（EDACS；II、III和IV-V级 vs I级）以及骨科手术史。由于与EDACS分类存在确认的完全共线性，喂养和吞咽困难被排除在所有回归模型之外。
结果： 生长迟缓（HAZ < -2 SD）是最普遍的人体测量学缺陷（65.4%），其次是体重不足（40.2%；n = 97）、消瘦（18.7%），以及≤5岁儿童的小头畸形（HCAZ < -2 SD：23.5%；n = 68）。GMFCS IV-V级的WAZ和HCAZ显著低于I-III级（均p < .05）。在多变量模型中，出现三个独立预测因素：年龄预测进行性线性身高生长迟缓（HAZ：B = -0.445/年，p < .001）；GMFCS IV-V级独立预测较低的WAZ（B = -1.022，p = .047）和较低的HCAZ（B = -1.051，p = .006）；骨科手术史是较低WAZ（B = -2.427，p = .001）和较低BAZ（B = -2.265，p < .001）的最强预测因素。多变量调整后，EDACS水平不能独立预测任何z评分。在年幼儿童中，年龄别头围对神经学和喂养相关脆弱性的敏感性高于年龄别BMI。
结论： 生长迟缓是该沙特CP队列中占主导地位的营养表型。运动严重程度、进行性年龄相关线性生长迟缓以及骨科手术史是人体测量学结局的独立预测因素。建议从诊断时起将WHO z评分监测与GMFCS和EDACS分类相结合，作为CP儿童营养监测的最低标准。

英文摘要

BACKGROUND: Growth faltering is a prevalent and clinically significant complication of cerebral palsy (CP), yet data from regional populations using standardized anthropometric outcomes remain limited.
OBJECTIVES: To quantify anthropometric deficits using WHO age- and sex-standardized z-scores and identify independent predictors in a clinical cohort of Saudi children with CP.
METHODS: A retrospective cross-sectional study of 107 Saudi children with CP (median age 4.3 years, IQR 2.4-6.2; 68.2% male). Anthropometric outcomes were expressed as weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BAZ), and head circumference-for-age (HCAZ) z-scores using WHO 2006/2007 reference standards. Between-group comparisons used Mann-Whitney U and Kruskal-Wallis tests with effect sizes (rank-biserial correlation; epsilon-squared). Four multivariable linear regression models were fitted using seven a priori predictors: age, sex, GMFCS level (IV-V vs I-III), eating and drinking ability (EDACS; Levels II, III, and IV-V vs I), and orthopedic surgery history. Feeding and swallowing difficulty was excluded from all regression models owing to confirmed perfect collinearity with EDACS classification.
RESULTS: Stunting (HAZ < -2 SD) was the most prevalent anthropometric deficit (65.4%), followed by underweight (40.2%; n = 97), wasting (18.7%), and microcephaly in children aged ≤ 5 years (HCAZ < -2 SD: 23.5%; n = 68). WAZ and HCAZ were significantly lower in GMFCS Levels IV-V than Levels I-III (both p < .05). In multivariable models, three independent predictors emerged: age predicted progressive linear height faltering (HAZ: B =  -0.445 per year, p < .001); GMFCS Levels IV-V independently predicted lower WAZ (B =  -1.022, p = .047) and lower HCAZ (B =  -1.051, p = .006); and orthopedic surgery history was the strongest predictor of lower WAZ (B =  -2.427, p = .001) and lower BAZ (B =  -2.265, p < .001). EDACS level did not independently predict any z-score after multivariable adjustment. Head circumference-for-age demonstrated greater sensitivity to neurological and feeding-related vulnerabilities than BMI-for-age in younger children.
CONCLUSIONS: Stunting is the dominant nutritional phenotype in this Saudi CP cohort. Motor severity, progressive age-related linear growth faltering, and orthopedic surgery history are independent predictors of anthropometric outcomes. Integration of WHO z-score monitoring with GMFCS and EDACS classification from the point of diagnosis is recommended as a minimum standard for nutritional surveillance in children with CP.