Department of Pediatrics, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, 150 06 Prague 5, Czech Republic.
Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Sokolovska 49/83, 186 75 Prague 8, Czech Republic.
Bone. 2018 Jan;106:22-27. doi: 10.1016/j.bone.2017.10.005. Epub 2017 Oct 7.
Sarcopenia and osteoporosis are among the late complications of type 1 diabetes (T1D) in adults. Whether and to what extent musculoskeletal impairment is present in childhood and adolescence has yet to be determined. The aim of this study was to assess volumetric bone mineral density (BMD) and dynamic muscle function in adolescents with T1D and to assess the clinical and biochemical predictors of their musculoskeletal system.
Ninety-five children and adolescents (59 boys and 36 girls, mean age 16.2±1.2years) with T1D were included in this cross-sectional study. Study participants were divided into two groups according to the duration of the disease (<6years and >9years, respectively). Volumetric BMD of the non-dominant tibia was assessed using peripheral quantitative computed tomography (pQCT). Dynamic muscle function was evaluated using jumping mechanography. Gender- and height-specific Z-scores were calculated using published reference data. HbA1c was evaluated retrospectively as an average over the past 5years.
Relative muscle power (P/mass) and force (F/body weight) were significantly decreased in T1D subjects (mean Z-scores -0.4±1.0; p<0.001, and -0.3±1.1; p<0.01, respectively). The duration of T1D negatively affected P/mass (p<0.01) but not F/body weight (p=0.54). Patients with T1D had also decreased trabecular BMD, the Strength-Strain Index and cortical thickness (mean Z-scores -0.8±1.3; -0.5±0.8 and -1.1±0.8, respectively, p<0.001 for all) whereas cortical BMD was increased when compared to controls (Z-score 1.2±0.90, p<0.001). No association was observed between the HbA1c and 25-hydroxyvitamin D levels and bone or muscle parameters.
T1D influences the musculoskeletal system in adolescence. Decreased muscle function could contribute to the osteoporosis reported in adult diabetic patients.
在成年 1 型糖尿病（T1D）患者中，肌少症和骨质疏松症是晚期并发症之一。儿童和青少年时期是否存在以及存在何种程度的肌肉骨骼损伤仍有待确定。本研究的目的是评估 T1D 青少年的容积骨密度（BMD）和动态肌肉功能，并评估其肌肉骨骼系统的临床和生化预测指标。
本横断面研究纳入了 95 名 T1D 儿童和青少年（59 名男孩和 36 名女孩，平均年龄 16.2±1.2 岁）。根据病程长短（分别为<6 年和>9 年）将研究参与者分为两组。使用外周定量计算机断层扫描（pQCT）评估非优势胫骨的容积 BMD。使用跳跃力学评估动态肌肉功能。使用已发表的参考数据计算性别和身高特异性 Z 分数。HbA1c 作为过去 5 年的平均值进行回顾性评估。
T1D 受试者的相对肌肉力量（P/体重）和力量（F/体重）显著降低（平均 Z 分数分别为-0.4±1.0；p<0.001 和-0.3±1.1；p<0.01）。T1D 的病程对 P/体重有负面影响（p<0.01），但对 F/体重没有影响（p=0.54）。与对照组相比，T1D 患者的骨小梁 BMD、强度-应变指数和皮质厚度也较低（平均 Z 分数分别为-0.8±1.3；-0.5±0.8 和-1.1±0.8，均 p<0.001），而皮质 BMD 较高（Z 分数 1.2±0.90，p<0.001）。HbA1c 和 25-羟维生素 D 水平与骨或肌肉参数之间无相关性。
T1D 会影响青少年的肌肉骨骼系统。肌肉功能下降可能导致成年糖尿病患者报告的骨质疏松症。
