Schachter Dina, Cartier Luis, Borzutzky Arturo
Department of Endocrinology, Clínica Santa María, Calle del Arzobispo 0665, Providencia, Santiago, Chile.
Bone. 2003 Aug;33(2):192-6. doi: 10.1016/s8756-3282(03)00225-4.
Human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been associated with changes in extracellular matrix of neural tissue. HTLV-I infection has multiple other systemic effects. Extracellular matrix is important for bone mineral deposition. We examined bone mineral density (BMD) in patients with HAM/TSP. BMD was assessed by ultrasonographic calcaneous densitometry in 24 patients (7 males, 17 females) with HAM/TPS, and 23 healthy HTLV-I-seronegative controls matched by age and sex. Patients with HAM/TPS had a mean BMD T-score of -3.07 +/- 0.64 in males and -2.93 +/- 0.69 in females. Control patients revealed a T-score of -0.77 +/- 1.31 in males and -1.17 +/- 1.08 females. The difference in T-score between HAM/TSP patients and control groups is significant (P < 0.001). Of HAM/TPS patients, 7 of 24 (29.2%) had osteopenia (T-score between -1 and -2.5) and 17 of 24 (70.8%) were diagnosed with osteoporosis (T < -2.5). Respective figures for control patients were 10 of 23 (43.5%) with a normal T-score, 11 of 23 (47.8%) with osteopenia, and 2 of 23 (8.7%) with osteoporosis. After adjustment for age and sex, odds ratio of osteoporosis for HAM/TSP patients was 31.52 (95% confidence interval, 5.07 to 195.88). No correlation was found in HAM/TSP patients between T-score and age, menstrual status, gait functionality, or years of evolution of HAM/TSP. HAM/TSP patients have a significantly diminished BMD of the calcaneous that appears not to be explained by paresis, age, years of disease, menstrual status; may be the result of systemic alterations due to HTLV-1 infection.
人类嗜T淋巴细胞病毒I型（HTLV-I）相关脊髓病/热带痉挛性截瘫（HAM/TSP）与神经组织细胞外基质的变化有关。HTLV-I感染还有多种其他全身效应。细胞外基质对骨矿物质沉积很重要。我们检测了HAM/TSP患者的骨密度（BMD）。通过超声跟骨骨密度测定法对24例（7例男性，17例女性）HAM/TPS患者和23例年龄和性别匹配的健康HTLV-I血清阴性对照者进行了BMD评估。HAM/TPS患者男性的平均BMD T值为-3.07±0.64，女性为-2.93±0.69。对照患者男性的T值为-0.77±1.31，女性为-1.17±1.08。HAM/TSP患者与对照组之间的T值差异有统计学意义（P<0.001）。在HAM/TPS患者中，24例中有7例（29.2%）患有骨质减少（T值在-1至-2.5之间），24例中有17例（70.8%）被诊断为骨质疏松症（T<-2.5）。对照患者的相应数字分别为23例中有10例（43.5%）T值正常，23例中有11例（47.8%）患有骨质减少，23例中有2例（8.7%）患有骨质疏松症。在对年龄和性别进行校正后，HAM/TSP患者患骨质疏松症的比值比为31.52（95%置信区间，5.07至195.88）。在HAM/TSP患者中，未发现T值与年龄、月经状况、步态功能或HAM/TSP病程之间存在相关性。HAM/TSP患者的跟骨BMD显著降低，这似乎无法用麻痹、年龄、病程、月经状况来解释；可能是HTLV- I感染导致全身改变的结果。
