Çocukluk çağı kronik karaciğer hastalıklarında kemik mineral dansitesi ölçümleri
Küçük Resim Yok
Tarih
1998
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışma Ege Üniversitesi Tıp Fakültesi Pediatrik Gastroenteroloji ve Beslenme Bilim Dalı'nda kronik karaciğer hastalığı tanısı ile izlenen, dördü kolestatik, 30 hastada (16 kız, 14 erkek-yaş ortalaması 12.3 yıl) hepatik osteopeni varlığının biyokimyasal, radyolojik ve kemik mineral dansitesi (KMD) ölçümleri ile belirlenmesi ve ileriye yönelik tedavi protokollerinin değerlendirilmesi amacı ile planlandı. Yaş ortalaması 13.6 yıl olan 20 sağlıklı çocuktan (dokuz kız, 11 erkek) kontrol grubu oluşturuldu. Tüm hastalarda, serum kalsiyum, fosfor, alkalen fosfataz, osteokalsin, insulin benzeri büyüme faktörü, idrar hidroksiprolin ölçümleri yapıldı. Hasta ve kontrollerde KMD ölçümleri XR-26 (Norland) kemik dansitometri cihazı ile dual enerji x-ray absorbsiyometri (DEXA) yöntemi ile yapıldı. Hastalar Child-Pugh sınıflamasına göre A (20 hasta) ve B+C (10 hasta) gruplarına ayrıldı. Serum osteokalsin düzeyleri hastaların tümünde normalin altında idi (ortalama 6.45 ng/ml). Hasta grubunun vertebral ve femoral KMD ölçümleri kontrollerden istatistiksel olarak anlamlı düzeylerde düşük bulundu (p=0.01 ve 0.003). Child A grubu KMD ölçümleri, L3 lateral bölgesinde kontrol grubundan anlamlı düşüklük gösteriyordu. Çalışma grubunun en düşük KMD ölçümleri kolestatik hastalarda saptandı. Sonuç olarak; hepatik osteopeni çocukluk çağı kolestatik ve nonkolestatik kronik karaciğer hastalıklarının önemli bir komplikas-yonudur. Bu oluşumda, düşük osteoklasin düzeylerinin işaret ettiği kemik "turnover" yavaşlaması etkin bir faktördür. Hastaların izleminde serum osteokalsin düzeyleri ve KMD ölçümleri yol göstericidir. Tanı aşamasından itibaren, osteopeninin önlenmesine yönelik destek tedavi verilmesi önemlidir.
This study was planned in Ege University Medical School, Department of Pediatrics, to detect hepatic osteopenia with biochemical, radiological methods and with bone mineral density (BMD) measurements and to review treatment protocols. Thirty children (16 female, 14 male, mean age 12.3 years) with chronic liver disease (4 of them cholestatic) and 20 children (9 female, 11 male, mean age 13.6 years) as controls were included in the study. Serum calcium, phosphorus, alkaline phosphate, osteocalcin, insulin-like growth factor and daily urine hydroxyproline measurements were performed in all patients. BMD measurements were performed in patients and controls with XR-26 (Norland) bone densitometer and with dual-energy x-ray absorptiometry (DEXA). Patients were divided into two groups according to Child-Pugh classification: A (20 patients) and B+C (10 patients). Serum osteocalcin values were decreased in all patients (mean: 6.45 ng/ml). Vertebral and femoral BMD measurements were statistically lower than those of controls (P: 0.01-0.003). BMD values in lateral L3 vertebrae of children in Child A group were significantly lower than those of controls. the lowest values of BDM in the study group belonged to cholestatic patients. Consequently, hepatic osteopenia is an important complication of childhood chronic cholestatic and noncholestatic liver disease. Impaired bone turnover, predicted by decreased osteocalcin levels, is an important factor. Thus, serum osteocalcin levels and BMD measurements may be valuable in the follow-up. We concluded that supportive management, as soon as the diagnosis is established, is essential for preventing osteopenia.
This study was planned in Ege University Medical School, Department of Pediatrics, to detect hepatic osteopenia with biochemical, radiological methods and with bone mineral density (BMD) measurements and to review treatment protocols. Thirty children (16 female, 14 male, mean age 12.3 years) with chronic liver disease (4 of them cholestatic) and 20 children (9 female, 11 male, mean age 13.6 years) as controls were included in the study. Serum calcium, phosphorus, alkaline phosphate, osteocalcin, insulin-like growth factor and daily urine hydroxyproline measurements were performed in all patients. BMD measurements were performed in patients and controls with XR-26 (Norland) bone densitometer and with dual-energy x-ray absorptiometry (DEXA). Patients were divided into two groups according to Child-Pugh classification: A (20 patients) and B+C (10 patients). Serum osteocalcin values were decreased in all patients (mean: 6.45 ng/ml). Vertebral and femoral BMD measurements were statistically lower than those of controls (P: 0.01-0.003). BMD values in lateral L3 vertebrae of children in Child A group were significantly lower than those of controls. the lowest values of BDM in the study group belonged to cholestatic patients. Consequently, hepatic osteopenia is an important complication of childhood chronic cholestatic and noncholestatic liver disease. Impaired bone turnover, predicted by decreased osteocalcin levels, is an important factor. Thus, serum osteocalcin levels and BMD measurements may be valuable in the follow-up. We concluded that supportive management, as soon as the diagnosis is established, is essential for preventing osteopenia.
Açıklama
Anahtar Kelimeler
Genel ve Dahili Tıp, Pediatri
Kaynak
Çocuk Sağlığı ve Hastalıkları Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
41
Sayı
3
