Bone mineral density in haemophilia patients
Bone mineral density in haemophilia patients
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DOI：
10.1160/th09-09-0629
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发表时间：
2010-03-01
影响因子：
6.7
通讯作者：
Filipponi, Paolo
中科院分区：
文献类型：
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作者：
Iorio, Alfonso;Fabbriciani, Gianluigi;Filipponi, Paolo
骨质疏松症是由骨矿物质密度（BMD）降低引起的。血友病患者患骨质疏松症的风险增加，因为减少体力活动和血液传播的病毒感染。本系统性文献综述旨在评价重度血友病患者的BMD降低及其与患者特征的相关性。对7项病例对照研究进行了荟萃分析，这些研究评估了重度血友病患者和对照组的腰椎BMD值[g/cm（2）]（所有研究）、BMI（5/7项研究）和丙型肝炎病毒（HCV）血清阳性（6/7项研究）。采用BMD标准化均值差（SMD）比较病例组和对照组。采用Meta回归分析研究了体重指数（BMI）和HCV感染的影响。101例成人病例（年龄33 +/- 8.9）和101例对照，111例儿科病例（年龄8 +/- 3.6）和307例对照可用于分析。重度血友病患者的腰椎BMD显著低于对照组，无论是成人（汇总SMD-1. 379，95%置信区间[CI]-2. 355至-0. 403，p= 0. 006）还是儿童（汇总SMD-0. 438，95% CI-0. 686至-0. 189，p= 0. 001）。与对照组相比，患者BMD的降低与BMI的降低或HCV感染患者的百分比无显著相关性。该荟萃分析证实了重度血友病与低BMD之间的相关性。未来的研究应该调查血友病患者的骨折率和预防骨质流失的干预措施
Osteoporosis is caused by bone mineral density (BMD) reduction. Haemophilia patients are at increased risk of osteoporosis because of decreased physical activity and blood-borne virus infections. This systematic review of the literature aims at evaluating BMD reduction in severe haemophilia patients and its correlation with patients' characteristics. Seven case-control studies evaluating lumbar BMD values [g/cm(2)] (all studies), BMI (5/7 studies), and hepatitis C virus (HCV) seropositivity (6/7 studies) in severe haemophilia patients and controls were meta-analysed. Standardised mean difference (SMD) of BMD was used to compare cases and controls. The effect of body mass index (BMI) and HCV infection was investigated by meta-regression. One hundred one adult cases (age 33 +/- 8.9) with 101 controls and 111 paediatric cases (age 8 +/- 3.6) with 307 controls were available for analysis. Lumbar BMD was significantly lower in severe haemophilia patients than in controls, both in adult (pooled SMD -1.379, 95% confidence interval [CI] -2.355 to -0.403, p=0.006) and children (pooled SMD -0.438, 95% CI -0.686 to -0.189, p=0.001). The reduction in BMD in patients versus controls was not significantly correlated with the reduction in BMI or with the percentage of HCV-infected patients. This meta-analysis confirms the association between severe haemophilia and low BMD. Future studies should investigate fracture rates and interventions to prevent bone loss in persons with haemophilia