Baroncelli G I, Bertelloni S, Ceccarelli C, Saggese G
Department of Pediatrics, University of Pisa, Italy.
J Clin Endocrinol Metab. 1998 Sep;83(9):3150-4. doi: 10.1210/jcem.83.9.5072.
The effect of anthropometric variables and bone size on bone mineral density (BMD) was examined in 22 children with GH deficiency (GHD) aged 6.1-8.0 yr at diagnosis and in 40 sex- and chronological age-matched controls. In all patients and controls, bone mineral content (BMC), BMDarea and BMD corrected for the apparent bone volume (BMDvolume) were measured by dual-energy x-ray absorptiometry in the lumbar spine at L2-L4 level. In patients, BMDarea was corrected for body height (BMDheight), body mass index (BMDBMI), and bone age (BMDBA). Patients showed significantly reduced (P < 0.0001) BMC (males 11.55 +/- 0.71 g, females 10.13 +/- 1.48 g) and BMDarea (males 0.502 +/- 0.033 g/cm2, females 0.515 +/- 0.034 g/cm2) compared with controls (BMC: males 18.09 +/- 1.23 g, females 15.58 +/- 1.87 g; BMDarea: males 0.689 +/- 0.065 g/cm2, females 0.685 +/- 0.059 g/cm2). In patients, BMDheight (males 0.537 +/- 0.031 g/cm2, females 0.548 +/- 0.032 g/cm2) and BMDBMI (males 0.641 +/- 0.028 g/cm2, females 0.624 +/- 0.035 g/cm2) remained significantly lower (P < 0.02 to P < 0.0001) than BMDarea of controls. BMDBA of patients was significantly reduced (-1.49 +/- 0.51 Z score, P < 0.0001) in comparison with bone age-matched controls (n = 35). BMDvolume was significantly lower (P < 0.01 to P < 0.0005) in patients (males 0.268 +/- 0.006 g/cm3, females 0.276 +/- 0.010 g/cm3) compared with chronological age-matched controls (males 0.283 +/- 0.013 g/cm3, females 0.293 +/- 0.017 g/cm3). Mean bone volume of patients was affected to a greater extent than bone area (-2.36 +/- 0.49 Z score and -1.56 +/- 0.70 Z score, respectively). Bone area/bone volume ratio was significantly higher in patients than in chronological age-matched controls (0.53 +/- 0.02 and 0.42 +/- 0.08, P < 0.0001, respectively). Chronological age, body height, BMI, and bone age correlated significantly with BMDarea (r2 = 0.389-0.450, P < 0.002 to P < 0.001) but not with BMDvolume (P = not significant). The results show that anthropometric variables and bone size affect lumbar BMC and BMDarea in children with GHD. Reduced lumbar BMDvolume indicates that apparent true bone density is decreased in children with GHD, suggesting a role of GH in bone mineralization.
在22例诊断时年龄为6.1 - 8.0岁的生长激素缺乏症（GHD）儿童以及40例性别和实际年龄匹配的对照组中，研究了人体测量学变量和骨骼大小对骨矿物质密度（BMD）的影响。对所有患者和对照组，采用双能X线吸收法测量L2 - L4水平腰椎的骨矿物质含量（BMC）、骨密度面积（BMDarea）以及校正表观骨体积后的骨密度（BMDvolume）。在患者中，BMDarea根据身高（BMDheight）、体重指数（BMDBMI）和骨龄（BMDBA）进行校正。与对照组相比，患者的BMC（男性11.55±0.71 g，女性10.13±1.48 g）和BMDarea（男性0.502±0.033 g/cm²，女性0.515±0.034 g/cm²）显著降低（P < 0.0001）（对照组：男性18.09±1.23 g，女性15.58±1.87 g；BMDarea：男性0.689±0.065 g/cm²，女性0.685±0.059 g/cm²）。在患者中，BMDheight（男性0.537±0.031 g/cm²，女性0.548±0.032 g/cm²）和BMDBMI（男性0.641±0.028 g/cm²，女性0.624±0.035 g/cm²）仍显著低于对照组的BMDarea（P < 0.02至P < 0.0001）。与骨龄匹配的对照组（n = 35）相比，患者的BMDBA显著降低（-1.49±0.51 Z评分，P < 0.0001）。与实际年龄匹配的对照组相比，患者的BMDvolume显著降低（P < 0.01至P < 0.0005）（男性0.268±0.006 g/cm³，女性0.276±0.010 g/cm³）（对照组：男性0.283±0.013 g/cm³，女性0.293±0.017 g/cm³）。患者的平均骨体积比骨面积受影响程度更大（分别为-2.36±0.49 Z评分和-1.56±0.70 Z评分）。患者的骨面积/骨体积比显著高于实际年龄匹配的对照组（分别为0.53±0.02和0.42±0.08，P < 0.0001）。实际年龄、身高、BMI和骨龄与BMDarea显著相关（r² = 0.389 - 0.450，P < 0.002至P < 0.001），但与BMDvolume无关（P = 无显著性差异）。结果表明，人体测量学变量和骨骼大小影响GHD儿童的腰椎BMC和BMDarea。腰椎BMDvolume降低表明GHD儿童的表观真实骨密度降低，提示生长激素在骨矿化中起作用。
