目的 探讨脑瘫患儿骨密度与疾病严重程度的相关性。方法 选取在南方医科大学第三附属医院就诊随访的1~4岁脑瘫患儿142例,按体格发育情况分为脑瘫发育迟缓组(82例)和脑瘫发育正常组(60例);按粗大运动功能分类系统(GMFCS)分为运动功能轻度障碍组40例(GMFCS 1～2级)、中度障碍组72例(GMFCS 3～4级)、重度障碍组30例(GMFCS5级),同时选取正常发育儿童57例作为对照组。探讨椎体和股骨近端骨密度、血清钙水平及胰岛素样生长因子-1(IGF-1)在各组之间的差异性,以及骨密度与GMFCS 分级的相关性。结果 脑瘫患儿的椎体和股骨近端的BMD水平明显低于健康对照组[腰椎(0.46±0.11) g/cm2 vs (0.56±0.13) g/cm2,P<0.001;股骨近端(0.43±0.06)g/cm2 vs (0.53±0.12)g/cm2,P<0.001]。脑瘫患儿椎体和股骨近端水平BMD与GMFCS分级之间呈显著负相关性(腰椎r=-0.363,P<0.001;股骨近端r=-0.491,P<0.001)。脑瘫患儿的血清钙及IGF-1水平明显低于健康对照组,GMFCS分级越高,血清钙及IGF-1水平就越低。结论 脑瘫患儿骨密度与疾病严重程度呈负相关性,表明脑瘫患儿骨代谢水平异常。
Abstract
Objective To investigate the correlations between bone mineral density(BMD) and disease severity in children with cerebral palsy(CP).Methods A total of 142 children with cerebral palsy who were aged 1 to 4 and followed up in our hospital were enrolled. According to their physical development, 82 cases were assigned to the group of CP with developmental delay and 60 cases to the group of normal CP. According to the gross motor function classification system (GMFCS), 40 patients were defined as mild motor impairment (GMFCS grade 1 to 2), 72 patients as moderate disorder (GMFCS grade 3 to 4), and 30 patients as severe disorder (GMFCS grade 5), while another 57 children with normal development were selected as control group. The difference in BMD, serum calcium levels, and insulin-like growth factor-1 (IGF-1) levels between these groups was studied. The correlations between BMD and GMFCS classification were analyzed.Results The levels of BMD in the vertebral column and proximal femur, serum calcium and IGF-1 in CP patients were significantly lower than those in the healthy control group[Lumbar:(0.46±0.11) g/cm2 vs (0.56±0.13) g/cm2,P<0.001; proximal femur (0.43±0.06) g/cm2 vs (0.53±0.12) g/cm2,P<0.001]. There was a significantly negative correlation between BMD and GMFCS grading in the vertebral column and proximal femur(Lumbar vertebra:r=-0.363,P<0.001; Proximal femur:r=-0.491,P<0.001). Serum calcium and IGF-1 levels were also decreased in CP patients compared with control. The higher GMFCS grading, the lower the levels of serum calcium and IGF-1.Conclusion There is a negative correlation between bone mineral density and disease severity in children with CP, indicating abnormal bone metabolism in children with cerebral palsy.
关键词
脑瘫 /
骨密度 /
疾病严重程度 /
血清钙 /
胰岛素样生长因子-1
Key words
cerebral palsy /
bone mineral density /
disease severity /
serum calcium /
insulin-like growth factor-1
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