Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA.
J Pediatr Gastroenterol Nutr. 2013 Jul;57(1):124-30. doi: 10.1097/MPG.0b013e318291fec5.
The aim of the present study was to determine whether bone mineral content (BMC) and density (BMD) of infants and children with parenteral nutrition (PN)-dependent intestinal failure (IF) is lower than healthy controls, and investigate potential causes of lower BMC and BMD.
We performed a cross-sectional study comparing infants and children with PN-dependent IF with duos of age-, sex-, and race-matched controls. Lumbar spine BMC and BMD were measured by dual-energy x-ray absorptiometry, and serum cytokines, aluminum, insulin-like growth factor-1 (IGF-1), IGF-binding protein 3 (IGF-BP3), parathyroid hormone, 25-hydroxy vitamin D, and 1,25-dihydroxy vitamin D were measured. Generalized estimating equation models accounting for matching were used for comparisons.
BMC was 15% and BMD was 12% lower in IF participants than in controls (P ≤ 0.004). Group differences were attenuated to 3% and 7% and were not statistically significant (P = 0.40 and P = 0.07) when adjusted for length and weight; length- and weight-for-age were lower in IF than in control participants (12.5% vs 63%; 29.5% vs 54%, P ≤ 0.03). IF participants had higher serum aluminum (23 vs 7 μg/L, P < 0.0001), IGF-1 (97 vs 64 ng/mL, P = 0.04), and 25-hydroxy vitamin D concentrations (40 vs 30 ng/mL, P = 0.0005), and lower IGF-BP3 (1418 vs 1812 ng/mL, P < 0.0001) and parathyroid hormone concentrations (51 vs 98 pg/mL, P = 0.0002) than controls. There was no difference in serum cytokine concentrations (P ≥ 0.09).
Growth retardation is a significant problem for patients with PN-dependent IF. Additional investigation is needed to elucidate the cause and its effect on bone mass and density, especially the role of IGF-1 resistance and aluminum toxicity.
本研究旨在确定接受肠外营养（PN）支持的肠道衰竭（IF）患儿的骨矿物质含量（BMC）和密度（BMD）是否低于健康对照，并探讨 BMC 和 BMD 降低的潜在原因。
我们进行了一项横断面研究，比较了接受 PN 支持的 IF 患儿与年龄、性别和种族相匹配的对照组。通过双能 X 射线吸收法测量腰椎 BMC 和 BMD，并测量血清细胞因子、铝、胰岛素样生长因子-1（IGF-1）、胰岛素样生长因子结合蛋白 3（IGF-BP3）、甲状旁腺激素、25-羟维生素 D 和 1,25-二羟维生素 D。采用考虑匹配的广义估计方程模型进行比较。
IF 组的 BMC 比对照组低 15%，BMD 低 12%（P ≤ 0.004）。当按身高和体重调整时，组间差异缩小至 3%和 7%，且无统计学意义（P = 0.40 和 P = 0.07）；IF 组的身高和体重-年龄均低于对照组（12.5%比 63%；29.5%比 54%，P ≤ 0.03）。IF 组的血清铝（23 比 7 μg/L，P < 0.0001）、IGF-1（97 比 64 ng/mL，P = 0.04）和 25-羟维生素 D 浓度（40 比 30 ng/mL，P = 0.0005）较高，而 IGF-BP3（1418 比 1812 ng/mL，P < 0.0001）和甲状旁腺激素浓度（51 比 98 pg/mL，P = 0.0002）较低。血清细胞因子浓度无差异（P ≥ 0.09）。
生长迟缓是接受 PN 支持的 IF 患者的一个严重问题。需要进一步研究阐明其病因及其对骨量和密度的影响，尤其是 IGF-1 抵抗和铝毒性的作用。
