Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal.
Inflamm Bowel Dis. 2010 Dec;16(12):2117-24. doi: 10.1002/ibd.21297.
The aim was to evaluate the presence of metabolic bone disease (MBD) in patients with Crohn's disease (CD) and to identify potential etiologic factors.
The case-control study included 99 patients with CD and 56 controls with a similar age and gender distribution. Both groups had dual-energy x-ray absorptionmetry and a nutritional evaluation. Single nucleotide polymorphisms at the IL1, TNF-α, LTα, and IL-6 genes were analyzed in patients only. Statistical analysis was performed using SPSS software.
The prevalence of MBD was significantly higher in patients (P = 0.006). CD patients with osteoporosis were older (P < 0.005), small bowel involvement and surgical resections were more frequent (P < 0.005), they more often exhibited a penetrating or stricturing phenotype (P < 0.05), duration of disease over 15 years (P < 0.005), and body mass index (BMI) under 18.5 kg/m(2) (P < 0.01) were more often found. No association was found with steroid use. Patients with a Z-score < -2.0 more frequently had chronic active disease (P < 0.05). With regard to diet, low vitamin K intake was more frequent (P = 0.03) and intake of total, monounsaturated, and polyunsaturated fat was higher in patients with Z-score < -2.0 (P < 0.05). With respect to genetics, carriage of the polymorphic allele for LTα252 A/G was associated with a higher risk of osteoporosis (P = 0.02). Regression analysis showed that age over 40 years, chronic active disease, and previous colonic resections were independently associated with the risk of developing MBD.
The prevalence of MBD was significantly higher in CD patients. Besides the usual risk factors, we observed that factors related to chronic active and long-lasting disease increased the risk of MBD.
本研究旨在评估克罗恩病（CD）患者是否存在代谢性骨病（MBD），并确定潜在的病因因素。
本病例对照研究纳入了 99 例 CD 患者和 56 例年龄和性别相匹配的对照者，所有患者均进行了双能 X 线吸收仪检测和营养评估。仅对 CD 患者进行了白细胞介素 1（IL1）、肿瘤坏死因子-α（TNF-α）、LTα 和白细胞介素 6（IL-6）基因的单核苷酸多态性分析。采用 SPSS 软件进行统计学分析。
CD 患者 MBD 的患病率显著高于对照组（P = 0.006）。骨质疏松症患者的年龄更大（P < 0.005），小肠受累和手术切除更常见（P < 0.005），更常表现为穿透性或狭窄性表型（P < 0.05），疾病持续时间超过 15 年（P < 0.005）和 BMI 小于 18.5 kg/m2（P < 0.01）的比例更高。未发现与皮质类固醇使用相关。Z 评分 < -2.0 的患者更常患有慢性活动性疾病（P < 0.05）。在饮食方面，维生素 K 摄入较低的患者更为常见（P = 0.03），Z 评分 < -2.0 的患者摄入总脂肪、单不饱和脂肪和多不饱和脂肪的比例更高（P < 0.05）。在遗传方面，LTα252 A/G 多态性等位基因的携带与骨质疏松症的风险增加相关（P = 0.02）。回归分析显示，年龄大于 40 岁、慢性活动性疾病和既往结肠切除术与 MBD 发生的风险独立相关。
CD 患者的 MBD 患病率显著升高。除了常见的危险因素外，我们还发现与慢性活动和长期疾病相关的因素增加了 MBD 的风险。
