Bendaly Edgard A, DiMeglio Linda A, Fadel William F, Hurwitz Roger A
Section of Pediatric Cardiology, Department of Pediatrics, Sanford Children's Hospital, University of South Dakota, 1600 W 22nd Street, PO Box 5039, Sioux Falls, SD, 57117, USA,
Pediatr Cardiol. 2015 Apr;36(4):779-85. doi: 10.1007/s00246-014-1083-3. Epub 2014 Dec 16.
Children with chronic diseases are at risk for low bone mineral density (BMD). There are no studies of BMD in children with congenital heart disease and particularly single ventricle (SV). Children with this defect are often treated with warfarin, suspected to negatively impact BMD in adults. We assessed BMD in patients with SV physiology and compared the BMD of subjects taking warfarin to those who were not. Subjects 5-12 years with SV were included. BMD z scores by dual-energy X-ray absorptiometry of the spine and total body less head (TBLH) were obtained. Calcium intake, activity level, height, and Tanner stage were assessed. Linear regression models and t tests were used to investigate differences between participants and normative data as well as between subjects' subgroups. Twenty-six subjects were included and 16 took warfarin. Mean BMD z score at the spine was significantly lower than expected at -1.0 ± 0.2 (p < 0.0001), as was the BMD z score for TBLH at -0.8 ± 0.2 (p < 0.0001). Those results remained significant after adjusting for height. Subjects who were on warfarin tended to have lower BMD at both the spine and TBLH than those who were not, with a z score difference of 0.6 ± 0.46 at the spine (p = 0.106) and a difference of 0.4 ± 0.34 at TBLH (p = 0.132). BMD is significantly reduced in children with SV. Warfarin appears to lower BMD but the effect is less conclusive. Continued evaluation is recommended for these patients at risk for reduced bone density. Evaluation of other cardiac patients on warfarin therapy should also be considered.
患有慢性疾病的儿童存在骨矿物质密度（BMD）低的风险。目前尚无关于先天性心脏病尤其是单心室（SV）患儿骨矿物质密度的研究。患有这种缺陷的儿童常接受华法林治疗，据怀疑这会对成人的骨矿物质密度产生负面影响。我们评估了具有SV生理特征患者的骨矿物质密度，并将服用华法林的受试者与未服用华法林的受试者的骨矿物质密度进行了比较。纳入了5至12岁患有SV的受试者。通过双能X线吸收法获得脊柱和除头部外全身（TBLH）的骨矿物质密度z评分。评估了钙摄入量、活动水平、身高和坦纳分期。使用线性回归模型和t检验来研究参与者与标准数据之间以及受试者亚组之间的差异。纳入了26名受试者，其中16名服用华法林。脊柱的平均骨矿物质密度z评分显著低于预期，为-1.0±0.2（p<0.0001），TBLH的骨矿物质密度z评分为-0.8±0.2（p<0.0001）。在调整身高后，这些结果仍然显著。服用华法林的受试者在脊柱和TBLH处的骨矿物质密度往往低于未服用华法林的受试者，脊柱的z评分差异为0.6±0.46（p = 0.106），TBLH处的差异为0.4±0.34（p = 0.132）。SV患儿的骨矿物质密度显著降低。华法林似乎会降低骨矿物质密度，但效果不太确凿。建议对这些有骨密度降低风险的患者进行持续评估。也应考虑对华法林治疗的其他心脏病患者进行评估。
