围产期感染艾滋病毒儿童中低维生素D和甲状旁腺激素浓度升高与骨矿物质密度的关联。
Associations of Low Vitamin D and Elevated Parathyroid Hormone Concentrations With Bone Mineral Density in Perinatally HIV-Infected Children.
作者信息
Jacobson Denise L, Stephensen Charles B, Miller Tracie L, Patel Kunjal, Chen Janet S, Van Dyke Russell B, Mirza Ayesha, Schuster Gertrud U, Hazra Rohan, Ellis Angela, Brummel Sean S, Geffner Mitchell E, Silio Margarita, Spector Stephen A, DiMeglio Linda A
机构信息
*Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA;†USDA Western Human Nutrition Research Center, University of California, Davis, CA;‡Division of Pediatric Clinical Research, Department of Pediatrics, Miller School of Medicine at the University of Miami, Miami, FL;§Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA;‖Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA;¶Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA;#Department of Pediatrics, University of Florida, Jacksonville, FL;**Nutrition Department, University of California, Davis, CA;††Maternal and Pediatric Infectious Disease (MPID) Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD;‡‡Frontier Science & Technology Research Foundation, Amherst, NY;§§The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA;‖‖Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, CA; and¶¶Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
出版信息
J Acquir Immune Defic Syndr. 2017 Sep 1;76(1):33-42. doi: 10.1097/QAI.0000000000001467.
BACKGROUND
Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual.
METHODS
PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children.
RESULTS
PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95% confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95% CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95% CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children.
CONCLUSIONS
PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed.
背景
围产期感染艾滋病毒（PHIV）的儿童，其骨矿物质密度（BMD）平均低于围产期暴露于艾滋病毒但未感染（PHEU）的儿童和健康儿童。25-羟基维生素D[25(OH)D]水平低和甲状旁腺激素（PTH）浓度升高可能导致骨量积累不理想。
方法
儿科艾滋病毒/艾滋病队列研究中的PHIV和PHEU儿童通过双能X线吸收法测量全身（TB）和腰椎（LS）的BMD及骨矿物质含量（BMC）；根据年龄和性别计算BMD z评分（BMDz）。25(OH)D水平低定义为≤20 ng/mL，PTH水平高定义为>65 pg/mL。我们拟合线性回归模型，以估计根据25(OH)D和PTH状态调整后的BMD/BMC平均差异，并拟合对数二项式模型，以确定PHIV儿童相对于PHEU儿童25(OH)D水平低和PTH水平高的调整患病率比。
结果
PHIV儿童（n = 412）比PHEU儿童（n = 207）年龄更大（13.0岁对10.8岁），黑人比例更高（76%对64%）。在PHIV儿童中，25(OH)D水平低的儿童TB - BMDz更低[标准差（SD），-0.38；95%置信区间（CI），-0.60至-0.16]，TB - BMC更低（SD，-59.1 g；95% CI，-108.3至-9.8）；PTH水平高且25(OH)D水平低与更低的TB - BMDz相关。在PHEU儿童中，25(OH)D水平低的儿童TB - BMDz更低（SD，-0.34；95% CI，-0.64至-0.03）。根据艾滋病毒感染状态，25(OH)D水平低的患病率相似（调整患病率比，1.00；95% CI，0.81至1.24）。PHIV儿童PTH水平高的可能性是PHEU儿童的3.17倍（95% CI，1.25至8.06）。
结论
25(OH)D水平低的PHIV和PHEU儿童可能BMD较低。在骨量积累的关键时期需要进行维生素D补充试验。
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