脑性瘫痪儿童的骨代谢生化特点

Biochemical characteristics of bone metabolism in children with cerebral palsy

目的：骨源性碱性磷酸酶与骨钙素在骨的形成过程中发挥着重要的调节作用，降钙素、甲状旁腺激素是调节体内Ca代谢的重要激素。测定脑性瘫痪患儿血钙、磷、骨源性碱性磷酸酶、骨钙素、降钙素、甲状旁腺激素水平，以了解其骨代谢生化特点及其相关的调控因素。方法：①对象及分组：选择2005-07/2007—07湖南省儿童医院康复中心住院的脑瘫患儿120例为脑瘫组：男82例，女38例：年龄3个月-3岁。按2005年昆明全国脑瘫会议分型标准分为痉挛型60例，不随意运动型60例；按脑瘫程度分为中轻度36例，中度42例，重度42例。同期体检的健康的100名儿童为对照组；男57名，女43名，年龄3个月-3岁。②检测指标及评估：采用全自动分析仪测定两组血清钙、磷水平；用小儿骨源性碱性磷酸酶试剂盒金标法测定骨碱性磷酸酶：用放射免疫吸附法测定骨钙素、降钙素、甲状旁腺激素，并进行两组间、不同程度与类型脑瘫患儿间比较。结果：①脑瘫组患儿血钙、磷与对照组比较差异无显著性（P〉0．05），骨碱性磷酸酶、骨钙素水平则明显高于对照组（P〈0．01），甲状旁腺激素、降钙素与对照组差异无统计学意义（均P〉0．05）。②脑瘫组中痉挛型组血骨钙素与不随意运动型组比较，差异无显著性（P〉0．05），但前者血甲状旁腺激素值高于后者，骨碱性磷酸酶值、降钙素值则低于后者，差异有显著性（均P〈0．05）。③重度脑瘫患儿的甲状旁腺激素高于对照组、降钙素低于对照组（均P〈0．01）；重度脑瘫患儿骨钙素、甲状旁腺激素值高于轻度和中度（均P〈0．05），降钙素低于轻度和中度（均P〈0．05）。结论：脑瘫患儿血清钙、磷可以通过机体自身血甲状旁腺激素、降钙素调控保持正常，而骨碱性磷酸酶、骨钙素水平升高则提示脑瘫患儿骨矿化不足，骨形成旺盛，骨重建活跃。

AIM： Bone alkaline phosphatase and osteocalcin play important roles in bone formation. Calcitonin and parathormone are the important hormones to adjust calcium metabolism. This study investigated the changes in the serum levels of calcium, phosphorus and bone alkaline phosphatase, osteocalcin, parathormone and calcitonin to explore bone metabolic biochemical characteristics and its relational regulation factors in the children with cerebral palsy. METHODS： ①120 children with cerebral palsy, who were hospitalized in the Center for Rehabilitation, Hunan Children Hospital between July 2005 and July 2007, were selected as cerebral palsy group, including 82 boys and 38 girls, aged from three months to three years old. There were 60 spastic and 60 dyskinetic cerebral palsy according to Kunming Cerebral Palsy Meeting in 2005, 36 mild, 42 moderate and 42 severe cerebral palsy. At the same time, 100 healthy children were selected as control group, 57 boys and 43 girls, aged from three months to three years old. ②The levels of serum calcium and phosphorus were measured by using an automation analyzer, bone alkaline phosphatase by using a bone alkaline phosphatase kit, osteocalcin, calcitonin and parathormone by the radioimmunoassay in 120 children with different type and severity of cerebral palsy and 100 healthy children, and compared with these outcomes between two groups, different types and severity Of children. RESULTS：①There was no significant difference in the levels of the serum calcium and phosphorus in children with cerebral palsy and healthy children （P 〉 0.05）. The levels of serum bone alkaline phosphatase and osteocalcin in the children with cerebral palsy were higher than that in the control group （P 〈 0.01）. There was no significant difference in the levels of parathormone and calcitonin between children with cerebral palsy and healthy children （P 〉 0.05）. ②There was no significant difference in the levels of the serum osteocalcin between spastic and dyskinetic cerebral palsy groups （P 〉 0.05）, but the levels of the serum parathormone in the former were higher than in the latter, and the levels of the serum bone alkaline phosphatase and calcitonin in the former were lower than in the latter （P 〈 0.05）. ③The serum parathormone and calcitonin levels in the children with severe cerebral palsy were respectively significantly higher and lower than that in the control group （P 〈 0.01）. Their serum parathormone and osteocalcin levels were significantly higher than that in the mild and moderate groups （P 〈 0.05）, but their serum calcitonin levels were significantly lower than that in the mild and moderate groups （P 〈 0.05）. CONCLUSION： The levels of serum calcium and phosphorus in cerebral palsy children are normal through self-adjustment （serum parathormone increasing, serum calcitonin decreasing）, but higher levels of serum bone alkaline phosphatase and osteocalcin indicate the poor bone mineralization, energetic bone formation and active bone rebuild in children with cerebral palsy.