Derepas Charlène, Kosar Christina, Avitzur Yaron, Wales Paul W, Courtney-Martin Glenda
Research Institute, The Hospital for Sick Children, Toronto, Canada.
Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.
JPEN J Parenter Enteral Nutr. 2015 Jan;39(1):85-94. doi: 10.1177/0148607113500695. Epub 2013 Aug 23.
Metabolic bone disease (MBD) is a well-recognized but poorly understood complication of long-term parenteral nutrition (PN). Bone histomorphometry in adults has provided useful information but does not provide quantitative measures of bone resorption and is to invasive for children. Measurement of bone turnover markers provides an alternative less invasive approach. We therefore aimed to measure bone turnover markers in children on long-term PN for intestinal failure (IF), and to compare them to age- and gender-matched controls.
Serum concentrations of osteocalcin (OC), bone-specific alkaline phosphatase (BSAP), and c-telopeptide (CTx) were measured in IF patients treated at a multidisciplinary intestinal rehabilitation and home PN program at the Hospital for Sick Children, Toronto, Canada. Age- and gender-matched control participants were recruited for comparison.
A total of 13 IF patients and 20 control participants were recruited. IF patients had lower serum OC and CTx concentrations when compared with controls: 42.43 ± 11.54 vs 68.39 ± 20.95 µg/L (P < .01) and 7.454 ± 2.17 vs 9.246 ± 1.92 (P < .05; mean ± SD) µg/L for OC and CTx, respectively. In a subgroup of 9 IF patients for whom BMD was available, OC and CTx concentration were negatively correlated to BMD (g/cm(2)) and BMD z score.
Bone turnover markers may be useful indicators for identifying children on long-term PN at risk of MBD. Further studies are needed to validate the current results and determine the factors that influence the occurrence and evolution of MBD in children on PN.
代谢性骨病（MBD）是长期肠外营养（PN）一种公认但了解不足的并发症。成骨组织形态计量学已提供了有用信息，但未提供骨吸收的定量测量方法，且对儿童具有侵入性。骨转换标志物的测量提供了一种侵入性较小的替代方法。因此，我们旨在测量因肠道衰竭（IF）接受长期PN治疗的儿童的骨转换标志物，并将其与年龄和性别匹配的对照组进行比较。
在加拿大多伦多病童医院多学科肠道康复和家庭PN项目中接受治疗的IF患者中，测量血清骨钙素（OC）、骨特异性碱性磷酸酶（BSAP）和C-末端肽（CTx）的浓度。招募年龄和性别匹配的对照参与者进行比较。
共招募了13名IF患者和20名对照参与者。与对照组相比，IF患者的血清OC和CTx浓度较低：OC分别为42.43±11.54 vs 68.39±20.95μg/L（P<.01），CTx分别为7.454±2.17 vs 9.246±1.92（P<.05；平均值±标准差）μg/L。在可获得骨密度的9名IF患者亚组中，OC和CTx浓度与骨密度（g/cm²）和骨密度z评分呈负相关。
骨转换标志物可能是识别长期接受PN治疗且有MBD风险儿童的有用指标。需要进一步研究来验证当前结果，并确定影响接受PN治疗儿童MBD发生和发展的因素。
