Avaliação da densidade mineral óssea em crianças com dermatite atópica moderada ou grave
Bone mineral density in children with moderate or severe atopic dermatitis
Ariana C. Yang; Vanessa R. A. Penterich; Rosa M. R. Pereira; Liliam Takayama; Marise Lazaretti-Castro; Jorge Kalil; Fábio F. M. Castro
Resumo
Objetivo: Determinar o impacto da Dermatite Atópica (DA) no estado nutricional e metabolismo ósseo em crianças. Métodos: Quarenta e nove crianças com DA moderada ou grave (4-12 anos) e 48 crianças saudáveis foram avaliadas por z-escore altura/idade, z-escore peso/idade, z-escore IMC, duração e gravidade da doença, uso de Glicocorticoides (GC) tópico e parâmetros ósseos. Conteúdo mineral ósseo (CMO), densidade mineral óssea (DMO) e z-escores foram medidos por absormetria de dupla emissão de raios-X (DXA). Níveis séricos de cálcio, fósforo, fosfatase alcalina, cortisol e telopeptídeo carboxiterminal do colágeno tipo 1 (CTX), e níveis plasmáticos de 25 hidroxivitamina D (25OHD) e hormônio da paratireoide (PTH), foram determinados. Resultados: Crianças com DA apresentaram menor altura para idade quando comparadas às crianças controle (p = 0,007). Menor CMO em coluna lombar [16,5 (6,4) vs. 19,8 (8,3)g, p = 0,027] e fêmur total [12,2 (4,0) vs. 14,2 (5,0)g, p = 0,029] foi encontrado em crianças com DA. Níveis de CTX foram menores em pacientes com DA [1,36 (0,59) vs. 1,67 (0,79)ng/mL, p = 0,026] e tendência a níveis mais baixos de fosfatase alcalina foi observada em crianças com DA [228 (75,3) vs. 255 (70,7) ng/mL, p = 0,074]. Crianças com DA apresentaram níveis mais baixos de cortisol que crianças saudáveis [9,06 (4.8) 10,57 vs. (4,9), p = 0,061], sem diferença significante. Conclusões: Redução em altura para idade, remodelamento ósseo e conteúdo mineral ósseo em crianças com DA moderada ou grave poderia estar associada a fatores incluindo determinantes genéticos, baixa exposição solar, inflamação crônica e uso crônico do GC tópico.
Palavras-chave
Abstract
Objective: To determine the impact of atopic dermatitis (AD) on nutritional status and bone metabolism parameters in children. Methods: Forty-nine children with moderate to severe AD (4-12 years old) and 48 healthy children were assessed using height/age z-scores, weight/age z-scores, body mass index z-scores, disease activity and severity, topical use of glucocorticoids (GC), and bone parameters. Bone mineral content (BMC), bone mineral density (BMD), and z-scores were measured using dual-energy X-ray absorptiometry (DXA). Serum levels of calcium, phosphorus, alkaline phosphatase, cortisol, and carboxy terminal telopeptide of type 1 collagen (CTX), and plasma levels of 25 hidroxy vitamin D (25OHD) and parathyroid hormone, were determined. Results: AD children presented lower height/age z-score, as compared to controls (p = 0.007). Lower BMC at lumbar spine [16.5(6.4) vs. 19.8(8.3)g, p = 0.027] and total femur [12.2(4.0) vs. 14.2(5.0)g, p = 0.029] was found in AD children. CTX levels were lower in AD patients, as compared to healthy children [1.36(0.59) vs. 1.67(0.79)ng/mL, p = 0.026] and a trend to lower levels of alkaline phosphatase was observed in AD children [228(75.3) vs. 255(70.7)ng/ mL, p = 0.074]. Children with AD presented lower levels of serum cortisol in comparison to the healthy group [9.06(4.8) vs. 10.57(4.9), p = 0.061], without statistical significance. Conclusions: Reduced height for age, BMD, and bone turnover in children with moderate to severe AD could be associated with genetic determinants, insufficient sun exposure, chronic inflammation, and chronic use of topical GC.
Keywords
References
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