青春期延迟患者骨骼定量多部位超声（QUS）测量骨量增加的纵向监测（一项初步研究）

Longitudinal monitoring of bone accretion measured by quantitative multi-site ultrasound (QUS) of bones in patients with delayed puberty (a pilot study).

作者信息

Zadik Zvi, Sinai Tali, Borondukov Ella, Zung Amnon, Yaniv Irit, Reifen Ram

机构信息

The Pediatric Endocrine Unit, Kaplan Medical Center, Hadassah Medical School, 76100 Rehovot, Israel.

出版信息

Osteoporos Int. 2005 Sep;16(9):1036-41. doi: 10.1007/s00198-004-1795-y. Epub 2004 Dec 23.

DOI:10.1007/s00198-004-1795-y

PMID:15616757

Abstract

OBJECTIVE

to compare the effect of anabolic agents on bone accretion in boys with constitutional delay of puberty (CGDP).

RATIONALE

it has been suggested that an appropriate timing of puberty is necessary for normal bone mineral density (BMD) acquisition. Proper bone development during childhood is the key factor in achieving higher peak bone mass during middle age, which may not be achievable in CGDP children, and thereby osteoporosis may appear at an earlier age then expected.

PATIENTS AND METHODS

45 boys with CGDP aged 14-16 years were monitored longitudinally, every 3 months over 12 months with Sunlight Omnisense, a quantitative ultrasound device (Tel Aviv, Israel). The apparatus is a multi-site bone sonometer that obtains axial Speed of Sound (SOS). Based on a reference database obtained on n=1,085 (490 boys) 0-18 years, a normative curve was determined. Fifteen (14-16 years old) of the CGDP patients were treated with I.M. testovirone depot 100 mg monthly for 6 months, 15 (14-16 years old) were treated with oxandrolone 5 mg/m(2) daily for 6 months, and 15 (14-16 years old) were in an observation group.

RESULTS

whereas the quantitative ultrasound (QUS) Z-score had shown some increase over time in CGDP-treated patients, an increase was found in tibia Z-score from -0.5(-0.64, -0.36) to -0.4(-0.54, -0.26) and from -0.52(-0.67, -0.38) to -0.31(-0.44, -0.11) in the testosterone and oxandrolone-treated groups, respectively, [median (25%, 75%)]. An increase in radius Z-score from -0.52(-0.65, -0.25) to -0.4(-0.54, -0.15) and from -0.51(-0.61, -0.21) to -0.37(-0.47, -0.07) in the testosterone- and oxandrolone-treated groups respectively [median (25%,75%)]. Z-score SOS decreased in the observation group -0.5(-0.66, -0.3) to -0.69(-0.85, -0.54) and -0.5(-0.59, -0.41) to -0.81(-0.95, -0.55) in tibia (P = 0.032) and radius (P = 0.029), respectively. Despite the fact that QUS remained in the normative range in all patients, a clear deterioration was demonstrated in untreated CGDP patients.

CONCLUSION

longitudinal follow-up of patients with CGDP may detect an early pattern of deterioration of bone mass.

摘要

目的

比较同化激素对体质性青春期延迟（CGDP）男孩骨量增加的影响。

理论依据

有研究表明，青春期适时启动对正常骨矿物质密度（BMD）的获取至关重要。儿童期骨骼的正常发育是中年时达到更高峰值骨量的关键因素，而这在CGDP儿童中可能无法实现，因此骨质疏松可能会比预期更早出现。

患者与方法

45名年龄在14 - 16岁的CGDP男孩接受了为期12个月的纵向监测，每3个月使用Sunlight Omnisense（一种定量超声设备，以色列特拉维夫）进行检查。该仪器是一种多部位骨超声仪，可获取轴向声速（SOS）。基于n = 1,085名（490名男孩）0 - 18岁儿童的参考数据库，确定了一条标准曲线。15名（14 - 16岁）CGDP患者每月接受100 mg的注射用睾酮治疗6个月，15名（14 - 16岁）接受氧雄龙5 mg/m²每日治疗6个月，15名（14 - 16岁）作为观察组。

结果

接受治疗的CGDP患者的定量超声（QUS）Z值随时间有所增加，睾酮治疗组胫骨Z值从-0.5（-0.64，-0.36）增至-0.4（-0.54，-0.26），氧雄龙治疗组从-0.52（-0.67，-0.38）增至-0.31（-0.44，-0.11），[中位数（25%，75%）]。睾酮治疗组桡骨Z值从-0.52（-0.65，-0.25）增至-0.4（-0.54，-0.15），氧雄龙治疗组从-0.51（-0.61，-0.21）增至-0.37（-0.47，-0.07），[中位数（25%，75%）]。观察组胫骨SOS的Z值从-0.5（-0.66，-0.3）降至-0.69（-0.85，-0.54），桡骨从-0.5（-0.59，-0.41）降至-0.81（-0.95，-0.55），差异有统计学意义（P = 0.032和P = 0.029）。尽管所有患者的QUS均在正常范围内，但未治疗的CGDP患者骨量明显下降。