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Doença óssea metabólica e doença inflamatória intestinal em idade pediátrica : experiência recente de um centro terciário
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Introdução: Cerca de 80% da massa óssea de um indivíduo é adquirida em idade pediátrica, pelo que este constitui um período crítico para o adequado desenvolvimento ósseo e crescimento linear. A Doença Inflamatória Intestinal (DII) em idade pediátrica pode comprometer a normal aquisição do capital mineral ósseo, condicionando um maior risco de desenvolvimento de atraso do crescimento e Doença Óssea Metabólica. Neste estudo, procurou-se caraterizar a repercussão no metabolismo ósseo e crescimento linear e determinar a prevalência e fatores preditivos de hipovitaminose D, na DII pediátrica, refletindo a experiência recente de um centro terciário. Material e Métodos: Estudo observacional, retrospetivo, baseado na consulta de processos clínicos de doentes com DII pediátrica, seguidos num centro hospitalar universitário, no período compreendido entre 2016-2021. Foram avaliados, ao diagnóstico e após um ano de follow-up, dados demográficos, clínicos, laboratoriais e densitometrias ósseas. Resultados: Foram incluídos 39 doentes (59% do sexo masculino; 13,4±3,6 anos); 30 com Doença de Crohn (DC), 7 com Colite Ulcerosa (CU) e 2 com Colite Não Classificada. O Z-score médio da estatura foi de -0,67±1,11, ao diagnóstico, e -0,77±1,01, ao follow-up, respetivamente (p=0,35). O nível sérico médio de 25(OH)D foi de 19,1±8,5 ng/ml, ao diagnóstico, e 18,5±6,7 ng/ml, ao follow-up, sem diferenças significativas entre DC e CU; 92,3% evidenciavam níveis inadequados de 25(OH)D ao diagnóstico (deficiência em 57,7%) e 100% ao follow-up (deficiência em 60%); 60% registava hipocalcémia, ao diagnóstico, e 18,2% ao follow-up. Observou-se uma correlação negativa entre os níveis de 25(OH)D sérica e calprotectina fecal (r=-0,59, p=0,004), mas não com outros fatores, incluindo com o fenótipo e duração da doença; 11% exibiam baixa estatura (tanto no basal, como no follow-up) e 14% apresentavam um Z-score de DMO<-2, sendo o Z-score médio de DMO significativamente inferior na DC Vs. CU (p=0,05). Conclusão: À semelhança de outras séries, identificou-se uma elevada prevalência de hipovitaminose D e de hipocalcémia em crianças/adolescentes com DII, quer ao diagnóstico, quer ao follow-up, bem como uma associação entre o nível sérico de vitamina D e a atividade da doença e entre a DOM e a DC, comparativamente à CU.
Introduction: Around 80% of an individual's bone mass is acquired in the paediatric age range, therefore this may be considered a critical period for the adequate bone development and linear growth. Paediatric inflammatory bowel disease (IBD) can impair the normal bone mineral capital acquisition, leading to an increased risk of delayed growth and bone metabolic disease. This study aimed to characterize the repercussions on bone metabolism and linear growth and to determine the prevalence and predictive factors of hypovitaminosis D in paediatric IBD, reflecting the recent experience of a tertiary centre. Material and Methods: This study has an observational and retrospective design, based on clinical records of paediatric IBD patients followed at a university hospital, between 2016-2021. Demographic, clinical, laboratory and bone densitometry data were assessed at diagnosis and after one year of follow-up. Results: 39 patients were included (59% male; 12.9±3.5 years); 30 with Crohn's Disease (CD), 7 with Ulcerative Colitis (UC) and 2 with Unclassified Colitis. The mean Z-score for height was -0.67±1.11 at diagnosis and -0.77±1.01 at follow-up, respectively (p=0.35). Mean serum 25(OH)D level was 19.1±8.5 ng/ml at diagnosis and 18.5±6.7 ng/ml at follow-up, with no significant differences between CD and UC; 92.3% had inadequate 25(OH)D levels at diagnosis (deficiency in 57.7%) and 100% at follow-up (deficiency in 60%); 60% had hypocalcaemia at diagnosis and 18.2% at follow-up. A negative correlation was observed between serum 25(OH)D levels and faecal calprotectin (r=-0.59, p=0.004), but not with other factors, including disease phenotype and duration; 11% exhibited short stature (both at baseline and follow-up) and 14% had an BMD Z-score <-2, with the mean BMD Z-score significantly lower in CD Vs. UC (p=0.05). Conclusion: Similarly to other series, we identified a high prevalence of hypovitaminosis D and hypocalcaemia in children/adolescents with IBD, both at diagnosis and follow-up, as well as an association between serum vitamin D level and disease activity and between DOM and CD, compared to UC.
Introduction: Around 80% of an individual's bone mass is acquired in the paediatric age range, therefore this may be considered a critical period for the adequate bone development and linear growth. Paediatric inflammatory bowel disease (IBD) can impair the normal bone mineral capital acquisition, leading to an increased risk of delayed growth and bone metabolic disease. This study aimed to characterize the repercussions on bone metabolism and linear growth and to determine the prevalence and predictive factors of hypovitaminosis D in paediatric IBD, reflecting the recent experience of a tertiary centre. Material and Methods: This study has an observational and retrospective design, based on clinical records of paediatric IBD patients followed at a university hospital, between 2016-2021. Demographic, clinical, laboratory and bone densitometry data were assessed at diagnosis and after one year of follow-up. Results: 39 patients were included (59% male; 12.9±3.5 years); 30 with Crohn's Disease (CD), 7 with Ulcerative Colitis (UC) and 2 with Unclassified Colitis. The mean Z-score for height was -0.67±1.11 at diagnosis and -0.77±1.01 at follow-up, respectively (p=0.35). Mean serum 25(OH)D level was 19.1±8.5 ng/ml at diagnosis and 18.5±6.7 ng/ml at follow-up, with no significant differences between CD and UC; 92.3% had inadequate 25(OH)D levels at diagnosis (deficiency in 57.7%) and 100% at follow-up (deficiency in 60%); 60% had hypocalcaemia at diagnosis and 18.2% at follow-up. A negative correlation was observed between serum 25(OH)D levels and faecal calprotectin (r=-0.59, p=0.004), but not with other factors, including disease phenotype and duration; 11% exhibited short stature (both at baseline and follow-up) and 14% had an BMD Z-score <-2, with the mean BMD Z-score significantly lower in CD Vs. UC (p=0.05). Conclusion: Similarly to other series, we identified a high prevalence of hypovitaminosis D and hypocalcaemia in children/adolescents with IBD, both at diagnosis and follow-up, as well as an association between serum vitamin D level and disease activity and between DOM and CD, compared to UC.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Doença inflamatória intestinal Idade pediátrica Vitamina D Doença óssea metabólica Atraso do crescimento Pediatria