Severe bone deformities in young children from vitamin D deficiency and fluorosis in Bihar-India
Severe bone deformities in young children from vitamin D deficiency and fluorosis in Bihar-India
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DOI：
10.1007/s00223-005-0233-2
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发表时间：
2005-06-01
影响因子：
4.2
通讯作者：
Sivakumar, B
中科院分区：
文献类型：
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作者：
Khandare, AL;Harikumar, R;Sivakumar, B
进行了一项病例对照研究，以了解比哈尔邦受氟化物影响的村庄幼儿骨骼畸形的病因病理学。选择两个村庄：一个村庄的饮用水氟化物含量较高（7.9 +/- 4.15 ppm），另一个村庄的氟化物含量正常（0.6 +/- 0.31 ppm）作为对照村。两个村庄的饮用水来源都是打井。选取高氟村（HFV）54户240名受试者和对照村197户1443名受试者进行研究。在 HFV 总人口中，50% 的人出现牙齿斑点 (DM)，20% 的人出现各种形式的骨骼畸形，而在对照村，DM 率为 6%，且不存在骨骼畸形。在 1.5 至 14 岁的年轻年龄组中，糖尿病和骨骼畸形的患病率都很高。膝外翻、膝内翻、胫骨弯曲、剑状胫骨和腕部长骨下端增宽是 HFV 受影响儿童中观察到的典型骨骼畸形。畸形儿童的X光检查显示骨骼有不同程度的弯曲，干骺端骨骺端增大，伴有骨骼磨损和韧带钙化。一项调查表明，与对照村相比，HFV 人口的钙和磷摄入量显着偏低，这可能分别是由于牛奶摄入量低和马铃薯摄入量高造成的。与对照组相比，HPV 儿童的平均尿氟化物水平显着较高，无论是否患有畸形。与HFV和对照村的无畸形儿童相比，畸形儿童的平均血清25 OHD3（25羟基维生素D）和钙水平显着较低，碱性磷酸酶活性显着较高。与对照村的儿童相比，患有和不患有 HFV 畸形的儿童的血清完整甲状旁腺激素 (IPTH) 水平较高。 HFV 村与对照村之间的血清和尿肌酐浓度以及铜、镁水平没有观察到显着差异。可以得出结论，一些 HFV 儿童表现出严重的骨骼畸形（佝偻病），血清钙和维生素 D 水平较低证实了这一点。
A case-control study was undertaken to understand the etiopathology of the bone deformities among young children in a fluoride-affected village of the Bihar State. Two villages were selected: one village with high fluoride in drinking water (7.9 +/- 4.15 ppm), and the other village with normal levels of fluoride (0.6 +/- 0.31 ppm) as the control village. The source of drinking water was bore wells in both the villages. Two hundred and forty subjects from 54 households (HHs) of the high-fluoride village (HFV) and 1443 subjects from 197 HHs of the control village were selected for the study. Dental mottling (DM) was observed in 50% and skeletal deformities of various forms were observed in 20% of the total population of HFV, whereas, in the control village, DM was 6% and skeletal deformities were absent. The prevalence of both, DM and skeletal deformities was high in the younger age group of 1.5 to 14 years. Genu valgum, genu varum, bowing of tibia, saber shin, and widening of the lower ends of long bones at the wrist were the typical skeletal deformities observed among affected children in the HFV. X-rays of the children with deformities revealed varying degrees of bending of bones and enlargement of epiphyseal ends of metaphyses with fraying of bone and ligamental calcification. A survey indicated significantly low calcium and high phosphorus intake among the population of the HFV as compared to that of the control village, possibly resulting from low intake of milk and high intake of potatoes, respectively. The mean urinary fluoride level was significantly higher in the children of the HPV, both with and without deformities, as compared to that of the control village. The mean serum 25 OHD3 (25 Hydroxy Vitamin D) and calcium levels were significantly lower and alkaline phophatase activity was significantly higher among the children with deformities as compared to those without deformities from the HFV and the control village. Serum intact parathyroid hormone (IPTH) levels were high in children both with and without deformities in the HFV as compared to those in the control village. No significant differences were observed in the concentration of serum and urinary creatinine, and Cu, and Mg levels between the HFV and the control village. It can be concluded that some of the children from the HFV manifested severe bone deformities (rickets), which were confirmed by the existence of low serum calcium and vitamin D levels.