Kociánová J, Axmann K
II. interní oddĕlení FN Bulovka, Praha.
Vnitr Lek. 1992 Oct;38(10):945-51.
In clinically active Crohn's disease the bone mineralization is impaired due to calcium malabsorption by the inflamed intestinal wall which is potentiated by diarrhoea and the thus accelerated transit time. To this we must add the shortening of the gut after operations, the inadequate dietary calcium supply or possibly calcium elimination in case of concurrent lactose intolerance. Corticoid treatment leads also to deterioration of bone mineralization. This is the reason why the authors assessed in 98 patients with Crohn's disease the bone mineralization, using the method of clavicular bone index (NIBA). Then treatment was started: a high protein diet, calcium forte, Ossin (sodium fluoride), vitamin D forte, anabolics and regular physical exercise. Check-up examinations after one year revealed that the index was restored in the majority of patients (60.84%) to normal. The above treatment is thus effective. It must be, however, regular and of a long-term character, in some patients it must extend over many years. We had, however, also patients who although subjected to an extensive resection of the gut and treated for prolonged periods with corticoids, had permanently an index between 100 and 120% without treatment.
在临床活动期的克罗恩病中，由于炎症肠壁对钙的吸收不良，加上腹泻以及由此加快的转运时间，导致骨矿化受损。此外，手术造成的肠管缩短、饮食中钙供应不足，或者在并发乳糖不耐受时可能出现的钙排泄增加，也会加重这种情况。皮质类固醇治疗同样会导致骨矿化恶化。这就是作者采用锁骨骨指数（NIBA）法对98例克罗恩病患者的骨矿化情况进行评估的原因。随后开始治疗：采用高蛋白饮食、钙补充剂、奥新（氟化钠）、高剂量维生素D、合成代谢药物以及定期体育锻炼。一年后的复查显示，大多数患者（60.84%）的指数恢复正常。因此，上述治疗方法是有效的。然而，治疗必须规律且长期进行，在某些患者中，治疗必须持续多年。不过，我们也有一些患者，尽管接受了广泛的肠切除术并长期使用皮质类固醇治疗，但未经治疗时其指数始终在100%至120%之间。
