Zusammenfassung
Ziel: Es sollte die ultraschallbasierte Ermittlung der Parameter Schallgeschwindigkeit
(SOS) und Schallabsorption (BUA) am Kalkaneus asthmakranker Kinder unter Berücksichtigung
von Geschlecht, Alter, Gewicht, Körperhöhe, Steroiddosis und Asthmaschweregrad (ASG)
ermittelt werden. Methoden: 178 Kinder (ASG 1 - 3, 98 Jungen, 80 Mädchen, 11,9 ± 3,1 J) wurden konsekutiv von
4/2000 - 9/2001 untersucht. BUA und SOS wurden ermittelt durch das System SAHARA™
(Hologic, USA). Regionale Referenzwerte von 3 299 Kindern (mit demselben System ermittelt)
wurden verwandt, um alters-, körperhöhen- und gewichtsbezogene Standard-Deviation-Scores
(SDS) in beiden Geschlechtern zu bestimmen. Der ASG und die Steroid-Therapie wurden
erfasst. Die maximale tägliche topische Steroiddosis betrug 500 µg Fluticason/800
µg Budesonid. Ergebnisse: 10/178 Kinder waren kleinwüchsig, 7 großwüchsig (5,6 %/3,9 %), 11/178 unter- und
9/178 übergewichtig (6,2 %/5,0 %). 19 bzw. 45 Kinder wiesen eine verringerte BUA bzw.
SOS auf (altersbezogen). Von verringerten Werten waren betroffen: Mädchen: BUA: 15,0
% (12/80), SOS 25,0 % (20/80); Jungen: BUA: 7,1 % (7/98), SOS: 25,5 % (25/98). Die
Geschlechtsunterschiede waren nicht signifikant. Die Verminderung der SOS korreliert
zum ASG und betrifft signifikant häufiger Kinder unter topischer Steroidtherapie (BUA:
0,09/0,25; SOS: - 0,37/- 0,07). Zusammenfassung: Nach unseren ersten Ergebnissen sind verringerte Schallgeschwindigkeiten des Kalkaneus
bei asthmakranken Kindern gehäuft aufgetreten, die mit der Asthmaschwere und der Steroidtherapie
(selbst bei niedrig dosierten topisch angewandten Steroiden) assoziiert waren. Dies
ist möglicherweise auf eine steroidinduzierte Kollagensynthesehemmung mit nachfolgend
verminderter Knochenelastizität zurückzuführen. Weiterführende Untersuchungen, insbesondere
Longitudinalstudien sind notwendig, um diesen Einfluss zu überprüfen.
Abstract
Purpose: To determine broadband ultrasound attenuation (BUA) and speed of sound (SOS) on the
os caicis in asthmatic children. To correlate these findings with sex, age, weight
and height, topical steroid intake, and asthma severity grade (ASG). Patients and Methods: 178 children (ASG 1 - 3)/(98 m, 80 f; mean age 11.9 ± 3.1 y) were consecutively chosen
from 4/00 to 9/01. Children with any other chronic disease were excluded. BUA and
SOS were measured using SAHARA™ (Hologic lnc. Waltham, USA). Regional normative BUA
and SOS data of 3 299 children (obtained with the same system), were used to calculate
age-, weight- and height-matched standard-deviation-scores (SDS) for both sexes. Asthma
severity grade and steroidal intake were determined. The highest topical steroid dosage
was 500 µg Fluticasone or 800 µg Budesonide per day. Results: 10/178 children were small and 7/178 tall per age (5.6 %/3.9 %), 11/178 children
were light (6.2 %) and 9 heavy per age (5.0 %). 19 and 45 children had reduced BUA
and SOS values, respectively. The following rates of reduced values were observed:
girls: BUA 15.0 % (12/80), SOS 25.0 % (20/80); boys: BUA 7.1 %, SOS 25.5 % (7/98 and
25/98). Sexual differences were not significant. Reduced SOS-values were associated
with higher severity and occurred significantly more frequent at children under steroidal
intake (0.09 vs. 0.25 [BUA] and - 0.37 vs. - 0.07 [SOS]). Conclusion: Following our results an increase incidence of reduced speed of sound occurs in asthmatic
children which is attributed to asthma severity and seems to be negatively influenced
even by topically applied low dose steroids. This could be attributed to a steroid
induced collagen synthesis deficiency followed by a reduced bone elasticity. Further
studies, especially using a longitudinal study design are required to verify these
findings.
Key words
BUA - SOS - asthma - steroids - childhood and adolescents
Literatur
1
Nicolai T, von Mutius E.
Pollution and the development of allergy: the East and West Germany story.
Arch Toxicol Suppl.
1997;
19
201-206
2
Cohen M B, Abram L E.
Growth patterns of allergic children: a statistical study using the grid technique.
J Allergy Clin Immunol.
1948;
19
165-171
3
David J.
Short Stature in Children with Atopic Eczema.
Acad Derm Venereol Suppl Stockh.
1989;
144
41-44
4
Wünsche K, Wünsche B, Fähnrich H, Mentzel H J, Vogt S, Abendroth K, Kaiser W A.
Ultrasound Bone Densitometry of the Os Calcis in children and adolescents.
Calcif Tissue Int.
2000;
67
349-355
5
Strelitzki R, Truscott J G.
An evaluation of the reproducibility and responsiveness of four “state of the art”
ultrasonic heel bone measurement systems using phantoms.
Osteoporos Int.
1998;
8
104-109
6
Schönau E.
Problems of bone analysis in childhood and adolescence.
Pediatr Nehpro.
1998;
12
420-429
7
Hans D, Schott A M, Dargent-Molina P. et al .
Is the WHO-criteria applicable to quantitative ultrasound measurement? The EPIDOS
prospective study.
Bone.
1998;
5
286
8
Wettengel R, Berdel D, Hofmann D. et al .
Empfehlungen zur Asthmatherapie bei Kindern und Erwachsenen.
Pneumologie.
1998;
52
591-601
9
Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß H C, Hesse V. et al .
Perzentile für den Body mass Index für das Kindes- und Jugendalter unter Heranziehung
verschiedener deutscher Stichproben.
Monatsschr Kinderheilkd.
2001;
149
807-818
10 The WHO Study group .
Assessment of fracture risk and its application to screening for menopausal osteoporosis.
Technical report series 843. Geneva; WHO 1994
11
Hans D, Dargent-Molina P, Schott A M. et al .
Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS
prospective study.
Lancet.
1996;
348
511-514
12
Bauer D C, Gluer C C, Cauley J A. et al .
Broadband ultrasound attenuation predicts-fractures strongly and independently of
densitometry in older women.
Arch Intern Med.
1997;
157
629-634
13
Frost M L, Blake G M, Fogelman I.
Quantitative ultrasound and bone mineral density are equally strongly associated with
risk factors for osteoporosis.
J Bone Min Res.
2001;
16
406-416
14
Rauch F, Schönau E.
Changes in bone density during childhood and adolescence: An approach based on bone's
biological organization.
J Bone Min Res.
2001;
16
597-604
15
Kromeyer-Hauschild K, Zellner K, Jaeger U, Hoyer H.
Prevalence of overweight and obesity among school children in Jena (Germany).
Int J Obes Realt Metab Disord.
1999;
23
1143-1150
16 Baum W F.
Anthropometrische und endokrinologische Untersuchungen asthmakranker Kinder - ein
Beitrag zum Problem atopiebedingter Störungen von Wachstum und Entwicklung. Halle; Universität, Med Fakultät, Habilitation 1992
17
Saha M T, Laippala P, Lenko H L.
Growth of asthmatic children is slower during than before treatment with inhaled glucocorticoids.
Acta Paediatr.
1997;
86
138-142
18
Frost M L, Blake G M, Fogelman I.
Can the WHO-criteria for diagnosing osteoporosis be applied to calcaneal quantitative
ultrasound?.
Osteoporos Int.
2000;
11
321-330
19
Faulkner K G, von Stetten E, Steiger P. et al .
Discrepancies in osteoporosis prevalence at different skeletal sites: Impact on the
WHO-criteria.
Bone.
1998;
5
194
20
Hans D, Wu C, Njeh C F. et al .
Ultrasound velocity of trabecular cubes reflects mainly bone density and elasticity.
Calcif Tissue Int.
1999;
64
18-23
21
Cheng S, Fan B, Wang L, Fuerst T, Lian M, Njeh C. et al .
Factors affecting broadband ultrasound attenuation results of the calcaneus using
a gel-coupled quantitative ultrasound scanning system.
Osteoporos Int.
1999;
10
495-504
22
Cheng S, Fan B, Wang L, Fuerst T, Lian M, Njeh C, He Y, Kern M, Lappin M, Tylavsky F,
Casal D, Harris S, Genant H K.
Factors affecting broadband ultrasound attenuation results of the calcaneus using
a gel-coupled quantitative ultrasound scanning system.
Osteoporos Int.
1999;
10
495-504
23
Agertoft L, Pederen S.
Bone mineral density in children with asthma receiving long-term treatment with inhaled
budesonide.
Am J Respir Crit Care Med.
1998;
157
178-183
24
Harmanci E, Colak O, Metintas M, Alatas O, Yurdasiper A.
Fluticasone propionate and budesonide do not influence bone metabolism in the long
term treatment of asthma.
Allergol Immunopathol.
2001;
29
22-27
25
Imamoto K, Saito N, Yamamura Y, Yamamura I.
Bone mineral density of the calcanei dissected from 30 cadavers - correlation of the
values by the DXA, QCT and USD methods.
Nippon Ronen Igakkai Zasshi.
1996;
33
597-602
26
Mehta S S, Oz O K, Antich P P.
Bone elasticity and ultrasound velocity are affected by subtle changes in the organic
matrix.
J Bone Miner Res.
1998;
13
114-121
27
Saarela T, Ristell J, Kauppila A, Koivisto M.
Effect of short term antenatal dexamethasone administration on type I collagen synthesis
and degradation in preterm infants at birth.
Acta Paediatr.
2001;
90
921-925
28
Reid I R, Evans M C, Wattie D J, Ames R, Cundy T F.
Bone mineral density of the proximal femur and lumbar spine in glucocorticoid-treated
asthmatic patients.
Osteoporos Int.
1992;
2
103-105
29
Vignolo M, Mascagni A, Brigone A, Battistini E, Fasce L, Spallarossa D, Rossi G A,
Aicardi G.
Effects of inhaled glucocortidoid prolonged treatment in asthmatic subjects on quantitative
ultrasonographic variables. “2nd international Congress on children's bone health,
Sheffield, GB 2002”.
Calcified tissue intern.
2002;
70
371
30
Düppe H, Gärdsell P, Johnell O, Nilsson B E, Ringsberg K.
Bone mineral density, muscle strength and physical activity. A population-based study
of 332 subjects aged 15 - 42 years.
Acta Orthop Scand.
1997;
68
97-103
31
Norstrom P O, Pettersson U, Lporentzon R.
Type of physical activity, muscle strength, and pubertal stage as determinants of
bone mineral density and bone area in adolescent boys.
J Bone Miner Res.
1998;
13
1141-1148
32
Boot A M, deJongste J C, Verberne A A, Pols H A, de Muinck Keizer-Schrama S M.
Bone mineral density and bone metabolism of prepubertal children with asthma after
long term treatment with inhaled corticosteroids.
Pediatr Pulmonol.
1997;
24
379-384
33
Crowley S, Trivedi P, Risteli L, Hindmarsh P C, Brook C G.
Collagen metabolism and growth in prepubertal children with asthma treated with inhaled
steroids.
J Pediatr.
1998;
132
409-413
34
Von Mutius E.
Presentation of new GINA guidelines for paediatrics. The global initiative on asthma.
Clin Exp Allergy.
2000;
30
16
35
Agertoft L, Pederen S.
Bone mineral density in children with asthma receiving long term treatment with inhaled
budesonide.
Am J Respir Crit Care Med.
1998;
157
178-183
A. Malich
Friedrich-Schiller-Universität, Institut für diagnostische und interventionelle Radiologie
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