Álvarez Zaragoza Citlalli, Vasquez-Garibay Edgar Manuel, García Contreras Andrea Anaís, Larrosa Haro Alfredo, Romero Velarde Enrique, Rea Rosas Alejandro, Cabrales de Anda José Luis, Vega Olea Israel Francisco
Universidad de Guadalajara.
Universidad De Guadalajara.
Nutr Hosp. 2019 Jul 1;36(3):517-525. doi: 10.20960/nh.2262.
Introduction: children with cerebral palsy (CP) have multiple risk factors for low bone mineral density or osteoporosis. Objective: to explore the association between bone mineral density (BMD) and biochemical and hormonal indicators of bone metabolism in children with quadriplegic cerebral palsy (CP). Methods: a cross-sectional analytical study included 59 participants from six to 18 years of age with quadriplegic CP. Serum concentrations of calcium, phosphorus, 25OHD metabolite, parathyroid hormone (PTH), alkaline phosphatase, and thyroid hormones were determined using standardized methods. The BMD measurement was obtained from the lumbar spine expressed in g/cm2 and Z-score. Unpaired Student's t-test, Chi-square test, odds ratio and Pearson's correlation were performed. Results: participants with CP and malnutrition had lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Those who had low BMD showed lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Most participants with low and normal BMD had vitamin D deficiency (27.1% and 10%) and insufficiency (35.4% and 30%), respectively. There was a significant correlation between BMD and serum concentrations of calcium, phosphorus, alkaline phosphatase, vitamin D and thyroid-stimulating hormone (TSH). There were no differences in the biochemical and hormonal indicators by level of gross motor function, use of anticonvulsants and oral versus enteral feeding method. Conclusion: malnutrition and alteration of vitamin D nutritional status were associated with low BMD and alterations of biochemical indicators of bone metabolism in pediatric patients with quadriplegic CP. The relationship between BMD and biochemical indicators of bone metabolism in children with quadriplegic CP was also demonstrated.
脑瘫患儿存在多种导致低骨矿物质密度或骨质疏松的风险因素。目的：探讨四肢瘫型脑瘫患儿骨矿物质密度（BMD）与骨代谢生化及激素指标之间的关联。方法：一项横断面分析研究纳入了59名6至18岁的四肢瘫型脑瘫患儿。采用标准化方法测定血清钙、磷、25OHD代谢物、甲状旁腺激素（PTH）、碱性磷酸酶和甲状腺激素的浓度。通过腰椎获取BMD测量值，以g/cm²和Z值表示。进行了非配对学生t检验、卡方检验、优势比和Pearson相关性分析。结果：患有脑瘫和营养不良的参与者血清钙、磷和碱性磷酸酶浓度较低。骨密度低的参与者血清钙、磷和碱性磷酸酶浓度较低。大多数骨密度低和正常的参与者分别存在维生素D缺乏（27.1%和10%）和不足（35.4%和30%）。BMD与血清钙、磷、碱性磷酸酶、维生素D和促甲状腺激素（TSH）浓度之间存在显著相关性。在粗大运动功能水平、抗惊厥药物使用以及口服与肠内喂养方式方面，生化和激素指标没有差异。结论：营养不良和维生素D营养状况改变与四肢瘫型脑瘫患儿的低骨密度和骨代谢生化指标改变有关。还证实了四肢瘫型脑瘫患儿BMD与骨代谢生化指标之间的关系。
