大剂量甲泼尼龙治疗儿童慢性特发性血小板减少性紫癜导致骨密度降低。

Reduced bone mineral density in childhood chronic idiopathic thrombocytopenic purpura treated with high-dose methylprednisolone.

作者信息

Dilber Cengiz, Dagdemir Ayhan, Albayrak Davut, Albayrak Selahattin, Kalayci Ayhan G, Aliyazicioglu Yuksel, Basoglu Tarik

机构信息

Department of Paediatrics, Medical Faculty, Ondokuz Mayis University, 55 139 Samsun, Turkey.

出版信息

Bone. 2004 Jul;35(1):306-11. doi: 10.1016/j.bone.2004.04.005.

DOI:10.1016/j.bone.2004.04.005

PMID:15207771

Abstract

PURPOSE

To evaluate whether repeated courses of high-dose methylprednisolone (HDMP) affect the lumbar spine bone mineral density (BMD) in children with chronic idiopathic thrombocytopenic purpura (ITP).

MATERIALS AND METHODS

This study included 24 patients with chronic ITP and 149 healthy controls. The patients were allocated into three groups according to the number of HDMP courses (30 mg/kg per day as a single dose for 7 days); group 1 (10 patients), group 2 (9 patients), and group 3 (5 patients) had received less than 5, 6-10, and more than 10 courses, respectively. Lumbar spine BMD and body composition were measured using dual energy X-ray absorptiometry of lumbar spine (L2-L4), and volumetric bone mineral density (vBMD) values were calculated and compared with the controls. The z score of the vBMD was also calculated and compared in the patients of each other groups. Serum markers of the bone turnover were measured to exclude other factors that could effect BMD.

RESULTS

The vBMD values of the patients, corrected BMDs for age, were significantly lower than the values of controls (P = 0.018). It was significantly lower in group 3 than groups 1 and 2 (P = 0.005 and P = 0.006, respectively), but there was no statistically significant difference between groups 1 and 2 (P = 0.87). The vBMD z scores were significantly lower in group 3 than in groups 1 and 2 (P = 0.003 and P = 0.004, respectively), and also in group 2 than in group 1 (P = 0.034). There were a weak negative correlation between the cumulative dose of HDMP and vBMD (r = -0.39, P = 0.054), and strong negative correlation between the cumulative dose of HDMP and vBMD z score (r = -0.63, P = 0.001).

CONCLUSION

Children with chronic ITP are at risk for decreased BMD because of the repeated courses of HDMP; especially more than 2100 mg of cumulative dose. We therefore recommend that BMD should be monitored in patients with chronic ITP who received repeated courses of HDMP.

摘要

目的

评估重复使用大剂量甲基强的松龙（HDMP）是否会影响慢性特发性血小板减少性紫癜（ITP）患儿的腰椎骨密度（BMD）。

材料与方法

本研究纳入24例慢性ITP患者和149例健康对照者。根据HDMP疗程数（30mg/kg每日单次剂量，共7天）将患者分为三组；第1组（10例患者）、第2组（9例患者）和第3组（5例患者）分别接受少于5个疗程、6 - 10个疗程和超过10个疗程的治疗。采用腰椎（L2 - L4）双能X线吸收法测量腰椎骨密度和身体成分，并计算体积骨密度（vBMD）值，与对照组进行比较。还计算并比较了各组患者vBMD的z评分。检测骨转换的血清标志物，以排除可能影响骨密度的其他因素。

结果

患者经年龄校正后的vBMD值显著低于对照组（P = 0.018）。第3组显著低于第1组和第2组（分别为P = 0.005和P = 0.006），但第1组和第2组之间无统计学显著差异（P = 0.87）。第3组的vBMD z评分显著低于第1组和第2组（分别为P = 0.003和P = 0.004），第2组也低于第1组（P = 0.034）。HDMP累积剂量与vBMD之间存在弱负相关（r = -0.39，P = 0.054），HDMP累积剂量与vBMD z评分之间存在强负相关（r = -0.63，P = 0.001）。