ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2020, Vol. 12 ›› Issue (4): 330-334.doi: 10.3969/j.issn.1674-3865.2020.04.015

• 临床研究 • 上一篇    下一篇

激素治疗对杜氏进行性肌营养不良骨健康的影响

陈婕妤，周怡瑶，赵蕾，李西华，钱甜   

  1. 201102 上海，复旦大学附属儿科医院临床营养科（陈婕妤，周怡瑶，钱甜），神经科（赵蕾，李西华）
  • 出版日期:2020-08-25 发布日期:2021-05-17
  • 通讯作者: 钱甜，E-mail：qiantianchina@gmail.com
  • 作者简介:陈婕妤（1983-），女，初级营养师。研究方向：儿科临床营养，儿童内分泌及遗传代谢营养治疗

Effect of hormone therapy on bone health of patients with Duchenne's muscular dystrophy

  • Online:2020-08-25 Published:2021-05-17

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摘要：

目的 探究糖皮质激素使用对杜氏肌营养不良症(DMD)患儿生长发育情况及骨代谢的影响。
方法 本研究回顾性分析2018年1月至2019年12月就诊于复旦大学附属儿科医院神经肌病门诊的有完整双能X线吸收测定法（DEXA）骨密度报告的DMD患儿。收集患儿的人体学测量指标，骨密度及部分血清25羟基维生素D的水平，并对上述数据进行分析。
结果 入选的99例均为男性患儿，平均年龄（7.2±2.1）岁。激素治疗患儿52例（占52.5%），平均激素使用时间为12.0（IQR 3.9，16.7）个月。未用激素组患儿较激素治疗组年龄小，分别为（6.3±2.0）岁和（8.0±1.9）岁，差异有统计学意义（P＜0.05）。未用激素患儿的年龄别身高Z值为-1.6±1.1；激素治疗组患儿的Z值为-2.1±1.5，差异无统计学意义（P=0.095）。未用激素患儿BMI的Z评分为IQR为0.17±1.50，激素治疗患儿BMI的Z评分为0.19±1.40，差异无统计学意义（P=0.35）。激素治疗患儿和未用激素患儿骨密度Z评分比较差异无统计学意义（P=0.294）。激素治疗患儿血清25-羟基维生素D值比未用激素患儿检测值高，分别为（19.8±8.5）μg/L和（17.7±1.3）μg/L，差异无统计学意义（P=0.45）。
结论 DMD患儿应常规完善相关骨代谢指标的监测和随访，2年以内激素治疗在给予相关营养素补充剂的同时不会显著影响骨密度值。

关键词: 杜氏进行性肌营养不良, 人体学测量, 骨密度, 儿童

Abstract: Objective To explore the effect of glucocorticoid on the growth and development of children with Duchenne's muscular dystrophy(DMD) and bone metabolism.
Methods This study retrospectively analyzed DMD children with complete dual-energy X-ray absorptiometry (DEXA) bone density reports who were admitted to the neuromyopathy clinic of Children's Hospital of Fudan University from January 2018 to December 2019. Anthropometric measurements, bone mineral density and serum levels of 25 hydroxyvitamin D were collected, and the above data were analyzed.
Results All the 99 patients enrolled were boys, with an average age of (7.2±2.1) years. Fifty-two children(52.5%) received glucocorticoids therapy, with an average duration of hormone therapy of 12.0(IQR 3.9,16.7) months. The age of the patients without glucocorticoids therapy were younger than the patients who received glucocorticoids therapy，［(6.3±2.0) years vs. 8.0±1.9 years, P<0.05］. The Z value of the age for height of the patients without glucocorticoids therapy was (-1.6±1.1), and the Z value of the patients with glucocorticoids therapy was (-2.1±1.5), P=0.095. The Z score of BMI of the patients without glucocorticoids therapy was (0.17±1.50), and in the patients with glucocorticoids therapy it was (0.19±1.40), P=0.35. There was no significant difference in Z score of bone mineral density(BMD) between the patients treated with hormone and those without hormone therapy, P=0.294. The serum 25-hydroxyvitamin D value of patients treated with hormone was higher than that of children who were not treated with hormone ［(19.8±8.5)μg/L vs. (17.7±1.3)μg/L, P=0.45］.
Conclusion The monitoring and followup of relevant bone metabolism indicators should be routinely improved in children with DMD. Glucocorticoids therapy within 2 years will not significantly affect bone mineral density if relevant nutrient supplements are given to patients.

Key words: DMD, Anthropological measuring, BMD, Children