Valerio Giuliana, Spadaro Raffaella, Iafusco Dario, Lombardi Francesca, Del Puente Antonio, Esposito Antonella, De Terlizzi Francesca, Prisco Francesco, Troncone Riccardo, Franzese Adriana
School of Movement Sciences (DiSiST), Parthenope University, Naples, Italy.
Department of Pediatrics, Federico II University, Naples, Italy.
Bone. 2008 Aug;43(2):322-326. doi: 10.1016/j.bone.2008.04.004. Epub 2008 Apr 18.
A reduced bone mineral density has been reported in patients with untreated celiac disease (CD) as well as in patients with poorly controlled type 1 diabetes mellitus (T1DM). The aim of this study was to evaluate the bone mineral status by phalangeal quantitative ultrasound in 52 children and adolescents with both diseases (mean age 13.3+/-4.9 years). As a control group 50 patients with T1DM and no CD (age 12.2+/-4.0 years) were studied. The following bone parameters, amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) were considered and expressed as z score. Compliance to gluten free diet and long term glycemic control (mean of four determinations of HbA1c in the last year) were also assessed. The lowest mean AD-SoS z score values were found in patients with T1DM and CD, who reported transgressions to gluten free diet and exhibited positivity for serum anti-tissue transglutaminase antibodies (tTG) and/or endomysial antibodies (EmA), compared with patients with occasional transgressions but negative for anti-tTG and/or -EmA, patients strictly adherent to the diet, and patients who suffered only from diabetes (ANOVA p=0.021). No difference was found between patients with diabetes alone and patients with both diseases strictly adherent to gluten free diet. Prevalence of osteopenia (z AD-SoS values <-2 SD) was higher in patients with T1DM and CD and poor compliance to the diet (45.5%) compared with patients with T1DM (8%) or patients with both diseases strictly compliant to diet (12.9%) (p=0.015). A negative correlation between Ad-SoS z score and HbA1c (r -0.236, p=0.036) was found when patients with T1DM and patients with T1DM and CD, who strictly adhere to the diet, were pooled. In conclusion the quality of bone as assessed by phalangeal ultrasound in patients with T1DM and CD, who strictly adhere to gluten free diet, is similar to that found in T1DM patients. A higher prevalence of osteopenia is present in patients with both diseases who reported habitual transgressions to gluten free diet. The gluten free diet, as well as the optimization of glycemic control, plays an important role in preventing the osteopenic status caused by the clustering of these two chronic diseases.
据报道，未经治疗的乳糜泻（CD）患者以及1型糖尿病（T1DM）控制不佳的患者骨矿物质密度降低。本研究的目的是通过指骨定量超声评估52例患有这两种疾病的儿童和青少年（平均年龄13.3±4.9岁）的骨矿物质状况。作为对照组，研究了50例患有T1DM但无CD的患者（年龄12.2±4.0岁）。考虑了以下骨参数，即振幅依赖声速（AD-SoS）和骨传导时间（BTT），并以z评分表示。还评估了无麸质饮食的依从性和长期血糖控制情况（过去一年中四次糖化血红蛋白（HbA1c）测定的平均值）。与偶尔违规但抗组织转谷氨酰胺酶抗体（tTG）和/或肌内膜抗体（EmA）阴性的患者、严格遵守饮食的患者以及仅患有糖尿病的患者相比，在报告违反无麸质饮食且血清抗tTG和/或EmA呈阳性的T1DM和CD患者中发现最低的平均AD-SoS z评分值（方差分析p=0.021）。仅患有糖尿病的患者与严格遵守无麸质饮食的两种疾病患者之间未发现差异。与T1DM患者（8%）或严格遵守饮食的两种疾病患者（12.9%）相比，T1DM和CD且饮食依从性差的患者中骨质疏松症（z AD-SoS值<-2 SD）的患病率更高（p=0.015）。当将严格遵守饮食的T1DM患者和T1DM及CD患者合并时，发现Ad-SoS z评分与HbA1c之间存在负相关（r=-0.236，p=0.036）。总之，通过指骨超声评估，严格遵守无麸质饮食的T1DM和CD患者的骨质量与T1DM患者相似。在报告习惯性违反无麸质饮食的两种疾病患者中，骨质疏松症的患病率更高。无麸质饮食以及血糖控制的优化在预防由这两种慢性病聚集引起的骨质减少状态方面起着重要作用。
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