Praticò G, Caltabiano L, Bottaro G, Palano G M, Rotolo N, Spina M
Clinica Pediatria II, Università di Catania, Italia.
Pediatr Med Chir. 1995 Sep-Oct;17(5):403-6.
The Authors studied the changes of the main parameters of calcium-phosphate metabolism in twenty four untreated celiac children (mean age: 23.7 +/- 14.4 months) and in eleven control subjects (mean age: 28.5 +/- 21.2 months). 16 patients were checked again one and three months after treatment was begun. Compared with controls patients show at diagnosis a significant increase of serum phosphate (P = 0.025) and a decrease of calcitonin levels (P = 0.02), whereas serum calcium is slightly lower and parathyroid hormone higher with serum levels above normal range in 5 of the coeliac patients (20.8%). During the three months of gluten free diet we find a significant increase of calcemia values (ANOVA: P = 0.025) together with a decrease of serum phosphate (ANOVA: P = 0.009) and of parathyroid hormone levels (ANOVA: P = 0.042). No significant change was found in vitamin D metabolites levels. The Authors conclude that coeliac disease affect clearly mineral metabolism. Actually the tendency to hypocalcemia, due to abnormalities of the intestinal mucosa, and the comparative iperphosphatemia, cause in some patients a compensatory increase of PTH levels. This increase seems to be the cause of the osteoporotic lesions described in current literature. Rickets due to the lack of vitamin D does not occur.
作者研究了24名未经治疗的乳糜泻患儿（平均年龄：23.7±14.4个月）和11名对照受试者（平均年龄：28.5±21.2个月）钙磷代谢主要参数的变化。16名患者在开始治疗1个月和3个月后再次接受检查。与对照组相比，患者在诊断时血清磷酸盐显著升高（P = 0.025），降钙素水平降低（P = 0.02），而血清钙略低，甲状旁腺激素较高，5名乳糜泻患者（20.8%）的血清水平高于正常范围。在无麸质饮食的三个月期间，我们发现血钙值显著升高（方差分析：P = 0.025），同时血清磷酸盐降低（方差分析：P = 0.009）和甲状旁腺激素水平降低（方差分析：P = 0.042）。维生素D代谢产物水平未发现显著变化。作者得出结论，乳糜泻明显影响矿物质代谢。实际上，由于肠黏膜异常导致的低钙血症倾向和相对的高磷血症，在一些患者中导致甲状旁腺激素水平的代偿性升高。这种升高似乎是当前文献中描述的骨质疏松性病变的原因。因缺乏维生素D导致的佝偻病并未发生。
