Corazza G R, Di Sario A, Cecchetti L, Jorizzo R A, Di Stefano M, Minguzzi L, Brusco G, Bernardi M, Gasbarrini G
Department of Internal Medicine, University of L'Aquila, Italy.
Bone. 1996 Jun;18(6):525-30. doi: 10.1016/8756-3282(96)00071-3.
Since no information is available on bone derangements in subclinical coeliac disease (CD), we evaluated bone mineral density (BMD, expressed as z score) at lumbar spine, by X-ray dual-photon absorptiometry, and serum indices of bone metabolism and remodeling in 14 subclinical or silent patients, 10 classical patients, and 15 healthy volunteers all on a gluten-containing diet. In the subclinical group, BMD at lumbar spine was significantly higher than in the classical group (-1.3 +/- 0.8, 73% vs. -2.6 +/- 0.6, 88%, respectively; p < 0.001), but significantly lower than in volunteers (+0.4 +/- 1.1, 104%; p < 0.001). Similar changes were observed in serum calcium, whereas, as regards parathyroid hormone, no significant difference was found between subclinical and classical patients. 25-vitamin D was significantly lower, and 1,25-vitamin D was significantly higher in subclinical and classical patients than in healthy volunteers. Indices of bone remodeling were higher in the subclinical and classical groups than in the volunteers, but lower in the subclinical than in classical patients. Eight subclinical and 8 classical patients were reexamined after a period of gluten-free diet (GFD), and in both groups BMD had significantly improved. Our results show that osteopenia is a frequent feature also in subclinical CD, although the extent of bone and mineral metabolism derangements is lower than in classical CD. GFD is able to normalize BMD in subclinical and to significantly improve it in classical patients.
由于目前尚无关于亚临床乳糜泻（CD）骨紊乱的信息，我们通过X线双能吸收法评估了14例亚临床或无症状患者、10例典型患者和15名健康志愿者（均食用含麸质饮食）的腰椎骨矿物质密度（BMD，以z值表示）以及骨代谢和重塑的血清指标。在亚临床组中，腰椎BMD显著高于典型组（分别为-1.3±0.8，7折；对比-2.6±0.6，88折；P<0.001），但显著低于志愿者组（+0.4±1.1，104折；P<0.001）。血清钙也观察到类似变化，而关于甲状旁腺激素，亚临床患者和典型患者之间未发现显著差异。亚临床和典型患者的25-维生素D显著低于健康志愿者，1,25-维生素D显著高于健康志愿者。亚临床组和典型组的骨重塑指标高于志愿者组，但亚临床组低于典型患者。8例亚临床患者和8例典型患者在一段时间的无麸质饮食（GFD）后接受复查，两组的BMD均有显著改善。我们的结果表明，骨质减少也是亚临床CD的常见特征，尽管骨和矿物质代谢紊乱的程度低于典型CD。GFD能够使亚临床患者的BMD正常化，并使典型患者的BMD显著改善。
