Erste Ergebnisse der ultraschallbasierten Bestimmung der Schallabsorption und Schallgeschwindigkeit bei Kindern mit Asthma bronchiale

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

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