Longitudinal changes of bone mineral density and metabolism in antiretroviral-treated human immunodeficiency virus-infected children
Longitudinal changes of bone mineral density and metabolism in antiretroviral-treated human immunodeficiency virus-infected children
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DOI：
10.1210/jc.2003-030767
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发表时间：
2004-01-01
影响因子：
5.8
通讯作者：
Viganò, A
中科院分区：
文献类型：
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作者：
Mora, S;Zamproni, I;Viganò, A
高效抗逆转录病毒疗法(HAART)可能是HIV感染儿童骨量减少和骨代谢改变的一个促成因素。然而，HAART过程中骨密度(BMD)和骨代谢的演变还没有得到研究。在目前的纵向研究中，我们监测了12个月期间骨密度和骨代谢的变化。32名感染艾滋病毒的儿童(15名女孩和17名男孩)参加了这项研究，年龄从6.3岁到17.7岁，长期接触HAART(基线时为40.0个月)。作为对照组，381名年龄相仿的健康志愿者接受了评估。用双能X线骨密度仪测量腰椎和整个骨骼的骨密度。分别测定血清和尿液中骨特异性碱性磷酸酶(BALP)和I型胶原N端肽(骨吸收指数)。基线时所有骨骼部位的骨密度值均显著低于对照组。脊柱骨密度的年增量与正常相当，而整个骨骼的年增量明显低于正常(P<；0.04)。BALP和I型胶原N端肽浓度在基线和随访时显著高于对照组。HIV患者BALP的年变化与正常人有显著差异。我们的数据证实了接受HAART治疗的HIV感染儿童存在低骨密度和骨代谢紊乱。儿科应评估恢复骨量和代谢的可能治疗方法的作用。
Highly active antiretroviral therapy (HAART) may be a contributory factor for a decreased bone mass and altered bone metabolism in HIV-infected children. However, the evolution of bone mineral density (BMD) and bone metabolism during HAART has not been studied yet. In the current longitudinal study we monitored the changes of BMD and bone metabolism over a period of 12 months. Thirty-two HIV-infected children (15 girls and 17 boys), aged from 6.3 to 17.7 yr, with a long duration of HAART exposure (40.0 months at baseline) were enrolled in the study. As a control group, 381 healthy volunteers of comparable age were assessed. BMD was measured at the lumbar spine and whole skeleton by dual-energy x-ray absorptiometry. Bone-specific alkaline phosphatase (BALP, as bone formation index) and N-terminal telopeptide of type I collagen (as bone resorption index) were measured in serum and urine, respectively. BMD values at baseline were significantly lower at all skeletal sites than those of control subjects. The annual increment of spine BMD was comparable to normal, whereas that of the whole skeleton was significantly lower (P < 0.04). BALP and N-terminal telopeptide of type I collagen concentrations were significantly higher compared with controls at baseline and at follow-up. BALP annual changes of HIV patients were significantly different from normal. Our data confirm the presence of low BMD and bone metabolism derangement in HIV-infected children treated with HAART. The role of possible therapeutic approach to restore bone mass and metabolism should be assessed in pediatrics.