Mainz Jochen G, Sauner Dieter, Malich Ansgar, John Stephanie, Beyermann Heike, Mentzel Hans-Joachim, Kaiser Werner A, Zintl Felix
Department of Pediatrics (Pediatric Pulmonology), Friedrich-Schiller-University of Jena, Kochstrasse 2, Jena, Germany.
J Bone Miner Metab. 2008;26(5):485-92. doi: 10.1007/s00774-008-0860-6. Epub 2008 Aug 30.
The aim of this study was to screen asthmatic children for bone density-related sonographic parameters on the calcaneal bone. Findings were correlated to therapy with inhaled corticosteroids (ICS) as well as with asthma severity (AS), concomitance and severity of atopic dermatitis (AD), and rhinitis (AR). We enrolled 173 children with AS1-3 consecutively; 44% (AS1) had not received any ICS medication; 56% (AS2 and -3) received ICS therapy for > or =6 months (medium daily dose, 286 microg fluticasone-proprionate-equivalent/maximum 500 microg); and in addition 38% (n = 65) presented with AD and 66% (n = 115) with AR. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) results were compared to regional normative values of 3299 children obtained with the identical system. ICS-treated children showed a tendency toward reduced age-, weight-, and height-adjusted standard deviation scores (SDS) for SOS compared to children without ICS treatment, which tendency did not reach statistical significance and was not as consistent for BUA (mean of ICS-treated children compared to our controls: SOS-SDS, -0.29/-0.31/-0.30; BUA-SDS, -0.23/-0.17/-0.05). For ICS-treated children, the proportion of patients with BUA and SOS values below -1 SDS was statistically significant higher for age-adjusted BUA and SOS than for children without ICS medication (BUA 15.00% vs. 5.41%; SOS 32.98% vs. 17.56%). However, we cannot differentiate possible negative effects of ICS from influences of the underlying inflammatory disease because higher asthma severity was associated with greater use of ICS medication. Additionally, the higher physical activity of children with less severe asthma can have influenced quantitative ultrasound (QUS) parameters positively, compared to patients with a higher degree of exercise-induced symptoms. For differentiation of possible negative effect of ICS on ultrasonic bone quality and for evaluation of the potentials of the method, further longitudinal QUS assessment of asthmatics receiving a new ICS treatment is needed.
本研究旨在筛查哮喘儿童跟骨上与骨密度相关的超声参数。研究结果与吸入性糖皮质激素（ICS）治疗、哮喘严重程度（AS）、特应性皮炎（AD）的合并症及严重程度以及鼻炎（AR）相关。我们连续纳入了173例AS1 - 3级的儿童；44%（AS1级）未接受任何ICS药物治疗；56%（AS2级和 - 3级）接受ICS治疗≥6个月（每日中等剂量，286微克丙酸氟替卡松等效剂量/最大500微克）；此外，38%（n = 65）患有AD，66%（n = 115）患有AR。将宽带超声衰减（BUA）和声速（SOS）结果与使用相同系统获得的3299名儿童的区域标准值进行比较。与未接受ICS治疗的儿童相比，接受ICS治疗的儿童在年龄、体重和身高调整后的SOS标准差评分（SDS）有降低的趋势，但该趋势未达到统计学意义，且对BUA而言并不一致（接受ICS治疗的儿童与我们的对照组相比的平均值：SOS - SDS，-0.29 / -0.31 / -0.30；BUA - SDS，-0.23 / -0.17 / -0.05）。对于接受ICS治疗的儿童，年龄调整后的BUA和SOS值低于 - 1 SDS的患者比例在统计学上显著高于未接受ICS药物治疗的儿童（BUA为15.00%对5.41%；SOS为32.98%对17.56%）。然而，我们无法区分ICS可能的负面影响与潜在炎症性疾病的影响，因为哮喘严重程度越高，ICS药物的使用量就越大。此外，与运动诱发症状程度较高的患者相比，哮喘较轻的儿童较高的身体活动水平可能对定量超声（QUS）参数产生了积极影响。为了区分ICS对超声骨质量可能的负面影响以及评估该方法的潜力，需要对接受新ICS治疗的哮喘患者进行进一步的纵向QUS评估。
