Falcini Fernanda, Bindi Giuseppe, Simonini Gabriele, Stagi Stefano, Galluzzi Fiorella, Masi Laura, Cimaz Rolando
Department of Pediatrics, Rheumatology Unit, University of Florence, Italy.
J Rheumatol. 2003 Jan;30(1):179-84.
To evaluate at baseline and after one year the bone status in children with chronic rheumatic diseases (CRD) using quantitative ultrasound techniques.
We evaluated bone status in 67 children, 52 female, 15 male, age range 2.80 to 18.10 years; 46 juvenile idiopathic arthritis, 11 juvenile dermatomyositis, and 10 systemic lupus erythematosus. Twenty-seven of 67 patients were taking only nonsteroidal antiinflammatory drugs (NSAID), 11 were given NSAID and methotrexate (MTX), 15 were also receiving steroids (prednisone), and 14 patients were given steroids and alendronate. Broadband ultrasound attenuation (BUA) by bone was determined at the left calcaneus using two 12.5 mm diameter, 1 MHz transducers mounted in hand-held calipers linked to a pediatric contact ultrasound bone analyzer.
At baseline in the whole patient group mean BUA values and Z scores were significantly lower than in controls: 41.84 +/- 21.64 vs 61.69 +/- 17.42 dB/MHz (p < 0.001); Z score -0.91 +/- 1.07 vs 0.09 +/- 0.62 in controls (p < 0.001). At one year followup in the patient group BUA values were significantly increased compared to baseline (BUA 46.43 +/- 21.51 dB/MHz; p = 0.002); no significant difference was found in Z score. The 15 children receiving steroids in addition to NSAID and MTX showed a decrease in BUA value at one year (NS), while Z scores were significantly reduced compared to baseline (-1.45 +/- 1.40 vs -1.08 +/- 1.11; p < 0.05). The 14 patients in the group receiving NSAID and MTX who also received alendronate showed significant increases in BUA (56.93 +/- 19.32 vs 44.21 +/- 15.67; p < 0.001) and Z score (-0.87 +/- 1.19 vs -1.56 +/- 0.82; p < 0.002).
Contact ultrasound bone analysis at the calcaneus is a useful tool in the assessment and monitoring of bone status in children with CRD.
使用定量超声技术在基线期和一年后评估患有慢性风湿性疾病（CRD）儿童的骨骼状况。
我们评估了67名儿童的骨骼状况，其中52名女性，15名男性，年龄范围为2.80至18.10岁；46例幼年特发性关节炎，11例幼年皮肌炎，10例系统性红斑狼疮。67例患者中，27例仅服用非甾体类抗炎药（NSAID），11例服用NSAID和甲氨蝶呤（MTX），15例还接受类固醇（泼尼松）治疗，14例患者接受类固醇和阿仑膦酸盐治疗。使用安装在与儿科接触式超声骨分析仪相连的手持卡尺中的两个直径12.5 mm、频率1 MHz的换能器，在左跟骨处测定骨的宽带超声衰减（BUA）。
在整个患者组的基线期，平均BUA值和Z评分显著低于对照组：41.84±21.64 vs 61.69±17.42 dB/MHz（p<0.001）；对照组的Z评分为-0.91±1.07 vs 0.09±0.62（p<0.001）。在患者组随访一年时，与基线期相比，BUA值显著增加（BUA 46.43±21.51 dB/MHz；p = 0.002）；Z评分未发现显著差异。除NSAID和MTX外还接受类固醇治疗的15名儿童在一年时BUA值下降（无显著性差异），而Z评分与基线期相比显著降低（-1.45±1.40 vs -1.08±1.11；p<0.05）。接受NSAID和MTX且还接受阿仑膦酸盐治疗的14例患者的BUA（56.93±19.32 vs 44.21±15.67；p<0.001）和Z评分（-0.87±1.19 vs -1.56±0.82；p<0.002）显著增加。
跟骨接触式超声骨分析是评估和监测CRD儿童骨骼状况的有用工具。
