脑瘫患儿同型半胱氨酸水平与骨密度的关联性

杨杰文; 黄绍逸; 黄闪; 邓浩荣; 陈亚军

doi:10.16835/j.cnki.1000-9817.2024346

脑瘫患儿同型半胱氨酸水平与骨密度的关联性

doi: 10.16835/j.cnki.1000-9817.2024346

1.
广州市社会福利院，广东 510000
2.
中山大学公共卫生学院妇幼卫生学系

基金项目:

广州市“岭南英杰工程”第二梯队后备人才项目穗人社函[2019]928号

详细信息

作者简介:
杨杰文(1972-)，男，广东广州人，博士，研究员，主要研究方向为儿童青少年健康教育

通讯作者:
陈亚军，E-mail: chenyj68@mail.sysu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R651.1⁺⁵ R748 R726.8
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出版历程
- 收稿日期: 2024-05-27
- 修回日期: 2024-07-28
- 网络出版日期: 2024-12-10
- 刊出日期: 2024-11-15

Association of cysteine level and bone mineral density among children with cerebral palsy

1.
Gunagzhou Social Welfare Institute, Guangzhou (510000), Guangdong Province, China

摘要

摘要: 目的了解脑瘫患儿血清同型半胱氨酸水平和腰椎骨密度(BMD)现况并分析两者的关联性，为改善脑瘫患儿骨健康提供参考。方法 2023年1月—2024年1月选取G市社会福利院(萝岗院区)的149名10~18岁脑瘫患儿，通过福利院病案系统导出脑瘫患儿基本人口学信息，采用酶循环法测量患儿血清同型半胱氨酸水平，由专业康复医师使用双能X线吸收法对患儿腰椎BMD进行测定，并计算腰椎身高校正BMD Z值(BMD HAZ值)。采用非限制性立方样条和分段多重线性回归分别分析脑瘫患儿血清同型半胱氨酸水平与腰椎BMD HAZ值的关联性。结果脑瘫患儿血清同型半胱氨酸浓度中位数为9.13(8.42，10.30)μmol/L，痉挛型脑瘫患儿浓度[9.28(8.53, 10.49)μmol/L]高于非痉挛型[8.64(7.89, 9.66)μmol/L](Z=-2.46，P < 0.05)。腰椎BMD HAZ值中位数为-1.07(-2.10，-0.16)，脑瘫患儿低BMD检出率为29.5%。脑瘫患儿血清同型半胱氨酸浓度与腰椎BMD HAZ值呈“L”型关联。当血清同型半胱氨酸浓度≤8.7 μmol/L时，腰椎BMD HAZ值与血清同型半胱氨酸浓度呈负相关(B=-0.32，95%CI=-1.06~-0.15，P < 0.05)。结论脑瘫患儿在较低血清同型半胱氨酸浓度下发现与腰椎BMD的负相关，提示其对同型半胱氨酸影响的敏感性可能较健康儿童青少年高，即使未达到高同型半胱氨酸血症标准也应引起重视。
- 脑性瘫痪 /
- 半胱氨酸 /
- 骨密度 /
- 回归分析 /
- 儿童
Abstract: Objective To investigate the association between cysteine level and lumbar spine (LS) bone mineral density (BMD) among children with cerebral palsy, so as to provide a basis for bone health enhancement among children with cerebral palsy. Methods A total of 149 children aged 10-18 with cerebral palsy who were admitted to the G city Social Welfare Institute (Luogang District) from January 2023 to January 2024. Basic demographic characteristics of children with cerebral palsy were extracted from medical records system. Cysteine levels were measured using the enzyme cycling method. LS BMD of the children was determined by specialized rehabilitation physicians using dual-energy X-ray absorptiometry, and the corrected BMD Z-scores for LS were calculated. Non-restrictive cubic splines and segmented multiple linear regression were employed to analyze the correlation between cysteine levels and age-specific height Z-scores (HAZ-scores) for LS BMD in children with cerebral palsy. Results The median cysteine concentration in children with cerebral palsy was 9.13(8.42, 10.30)μmol/L, with significantly higher levels in spastic type children [9.28(8.53, 10.49)μmol/L] compared to non-spastic types [8.64(7.89, 9.66)μmol/L](Z=-2.46, P < 0.05). The median LS BMD HAZ-score was -1.07(-2.10, -0.16), and the detection rate of decreased bone mass was 29.5%. There was an "L"-shaped association between serum homocysteine concentration and LS BMD HAZ-score in children with cerebral palsy. When serum homocysteine concentration was below 8.7 μmol/L, a significant negative correlation was observed between LS BMD HAZ-score and serum homocysteine concentration (B=-0.32, 95%CI=-1.06 to -0.15, P < 0.05). Conclusions The significant negative correlation between cysteine levels and LS BMD in children with cerebral palsy at lower cysteine concentrations, which suggests a potentially higher sensitivity to the influence of homocysteine than healthy children and adolescents, warranting attention even if not reaching the standard of hyperhomocysteinemia.
- Cerebral Palsy /
- Cysteine /
- Bone density /
- Regression analysis /
- Child
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 脑瘫患儿血清Hcy浓度与LS BMD HAZ值RCS曲线

Figure 1. RCS curve of serum Hcy and LS BMD HAZ score among children with cerebral palsy

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表 1 不同组别脑瘫患儿血清Hcy水平比较[M(P₂₅, P₇₅), μmol/L]

Table 1. Comparison of the serum Hcy concentration in children with cerebral palsy [M(P₂₅, P₇₅), μmol/L]

组别	选项	人数	血清Hcy水平	Z/H值	P值
年龄/岁	11~12	23	8.81(8.31, 9.87)	3.57	0.31
	13~14	43	9.11(8.59, 10.21)
	15~16	48	9.09(8.30, 10.17)
	17~18	35	9.46(8.53, 10.59)
性别	男	86	9.01(8.30, 10.30)	-0.75	0.45
	女	63	9.28(8.57, 10.32)
BMI	正常	36	8.96(8.26, 10.29)	-0.52	0.60
	消瘦	113	9.14(8.45, 10.30)
脑瘫分型	痉挛型	115	9.28(8.53, 10.49)	-2.46	< 0.05
	非痉挛型	34	8.64(7.89, 9.66)
GMFCS分级	轻度	32	8.89(8.38, 10.21)	-0.66	0.51
	中重度	117	9.19(8.43, 10.38)
25-羟基维生	正常	132	9.08(8.40, 10.21)	-1.56	0.12
素D水平	不足/缺乏	17	10.21(8.95, 10.55)
叶酸水平	正常	138	9.10(8.41, 10.24)	-1.51	0.13
	缺乏	11	10.13(8.61, 10.80)
吞咽功能障碍	是	40	9.27(8.02, 10.45)	-0.31	0.76
	否	109	9.09(8.49, 10.25)
癫痫	是	44	9.16(8.48, 10.23)	-0.03	0.96
	否	105	9.11(8.38, 10.51)

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表 2 不同组别脑瘫患儿腰椎BMD HAZ评分比较[M(P₂₅, P₇₅)]

Table 2. Comparison of lumbar BMD HAZ score in children with cerebral palsy [M(P₂₅, P₇₅)]

组别	选项	人数	统计值	L1	L2	L3	L4	LS BMD
年龄/岁	11~12	23		-0.80(-1.50, -0.34)	-1.17(-1.93, -0.39)	-1.37(-1.81, -0.37)	-0.97(-1.59, -0.17)	-1.07(-1.80, -0.47)
	13~14	43		-1.34(-1.87, -0.43)	-1.27(-2.51, -0.53)	-1.15(-2.30, -0.45)	-1.13(-2.20, -0.20)	-1.25(-2.65, -0.55)
	15~16	48		-0.50(-1.58, 0.18)	-0.79(-1.68, 0.24)	-0.91(-1.91, 0.13)	-0.63(-1.79, 0.01)	-0.89(-2.10, 0.02)
	17~18	35		-0.34(-1.49, 0.41)	-0.13(-1.65, 0.48)	-0.21(-1.76, 0.41)	-0.62(-1.75, 0.06)	-0.42(-2.05, 0.21)
			H值	6.09^*	9.91^*	5.22	2.12	3.16
性别	男	86		-0.62(-1.35, 0.20)	-0.66(-1.32, 0.24)	-0.63(-1.43, 0.16)	-0.59(-1.32, 0.06)	-0.74(-1.47, 0.13)
	女	63		-1.36(-2.18, -0.34)	-1.84(-2.79, -0.25)	-1.77(-2.86, -0.37)	-1.60(-2.62, -0.15)	-2.16(-3.00, -0.27)
			Z值	-3.32^*	-4.35^**	-4.28^**	-3.79^**	-4.37^**
BMI	正常	36		-0.34(-1.22, 0.55)	-0.20(-1.23, 0.53)	-0.09(-1.57, 0.46)	-0.06(-1.01, 0.63)	-0.22(-1.44, 0.32)
	消瘦	113		-1.05(-1.78, -0.25)	-1.17(-2.01, -0.21)	-1.27(-1.96, -0.28)	-1.13(-1.94, -0.26)	-1.26(-2.25, -0.45)
			Z值	-2.77^*	-3.06^*	-3.06^*	-3.79^*	-3.34^*
脑瘫分型	痉挛型	115		-1.00(-1.77, -0.06)	-1.10(-1.93, 0.06)	-1.15(-1.95, -0.04)	-1.11(-1.98, -0.15)	-1.26(-2.25, -0.24)
	非痉挛型	34		-0.56(-1.35, -0.02)	-0.71(-1.38, 0.01)	-0.59(-1.45, 0.37)	-0.41(-1.21, 0.48)	-0.68(-1.45, 0.25)
			Z值	-1.31	-1.31	-1.73	-2.38^*	-1.97^*
GMFCS分级	轻度	32		-0.40(-1.32, 0.32)	-0.62(-1.30, 0.27)	-0.53(-1.41, 0.41)	-0.22(-1.18, 0.46)	-0.57(-1.31, 0.27)
	中重度	117		-0.84(-1.78, -0.07)	-1.06(-2.03, -0.05)	-1.15(-1.97, -0.06)	-1.10(-2.01, -0.19)	-1.26(-2.27, -0.27)
			Z值	-1.95	-2.13^*	-2.00^*	-2.69^*	-2.67^*
维生素D	正常	132		-0.78(-1.64, -0.03)	-0.80(-1.92, 0.06)	-0.88(-1.89, 0.08)	-0.92(-1.76, -0.04)	-1.00(-2.13, -0.05)
水平	不足/缺乏	17		-1.32(-1.85, -0.36)	-1.22(-2.04, -0.41)	-1.33(-2.03, -0.56)	-1.18(-1.81, -0.25)	-1.38(-2.13, -0.51)
			Z值	-1.16	-0.98	-1.06	-0.62	-1.00
叶酸水平	正常	138		-0.82(-1.65, -0.08)	-0.92(-1.92, -0.07)	-0.99(-1.87, 0.03)	-0.95(-1.74, -0.08)	-1.14(-2.01, -0.21)
	缺乏	11		-0.43(-1.62, 0.79)	0.07(-2.52, 0.59)	-0.37(-2.72, 0.19)	-0.21(-2.62, -0.03)	-0.41(-2.82, 0.29)
			Z值	-0.81	-0.77	-0.22	-0.08	-0.39
吞咽功能	是	40		-1.39(-2.25, -0.29)	-1.57(-2.81, -0.40)	-1.53(-2.82, -0.52)	-1.51(-2.32, -0.27)	-1.72(-3.17, -0.60)
障碍	否	109		-0.76(-1.42, 0.04)	-0.74(-1.73, 0.16)	-0.75(-1.77, 0.17)	-0.72(-1.62, 0.06)	-0.82(-1.83, 0.08)
			Z值	-2.34^*	-3.17^*	-2.87^*	-3.00^*	-3.01^*
癫痫	是	44		-1.16(-1.70, -0.01)	-1.05(-1.93, -0.12)	-1.16(-1.75, -0.11)	-0.99(-1.52, -0.17)	-1.24(-1.80, -0.41)
	否	105		-0.77(-1.64, -0.06)	-0.86(-1.90, 0.07)	-0.85(-1.97, 0.17)	-0.90(-1.87, 0.02)	-0.99(-2.26, 0.04)
			Z值	-0.73	-0.43	-0.21	-0.17	-0.31
总体		149		-0.80(-1.64, -0.06)	-0.87(-1.92, 0.05)	-0.97(-1.91, 0.05)	-0.94(-1.76, -0.07)	-1.07(-2.10, -0.16)
注：^P < 0.05，^*P < 0.01。

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表 3 脑瘫患儿血清Hcy水平与LS BMD HAZ值关联性多重线性回归分析[B值(95% CI), n=149]

Table 3. Segmented multiple linear regression of serum Hcy with LS BMD HAZ score among children with cerebral palsy[B(95% CI), n=149]

变量	选项	Hcy≤8.7 μmol/L	Hcy>8.7 μmol/L
年龄/岁	11~14	-0.41(-1.22~-0.07)^*	0.15(-0.15~0.57)
	15~18	-0.29(-1.63~0.28)	0.08(-0.20~0.37)
性别	男	-0.26(-0.92~0.13)	-0.09(-0.30~0.16)
	女	-0.55(-2.42~0.06)	0.23(-0.09~0.75)
BMI	正常	-0.71(-3.81~1.35)	0.23(-0.30~0.74)
	消瘦	-0.34(-1.28~-0.12)^*	0.19(-0.04~0.43)
脑瘫分型	痉挛型	-0.35(-1.26~-0.09)^*	0.04(-0.18~0.28)
	非痉挛型	-0.32(-2.00~0.84)	0.35(-1.03~2.01)
GMFCS分级	轻度	-0.37(-2.05~0.78)	-0.01(-0.81~0.80)
	中重度	-0.34(-1.16~-0.18)^*	0.06(-0.17~0.31)
维生素D水平	不足/缺乏	—	0.05(-0.19~0.30)
	正常	-0.34(-1.10~-0.20)^*	-0.55(-2.88~1.23)
叶酸水平	缺乏	—	—
	正常	-0.34(-1.06~-0.21)^*	0.01(-0.20~0.22)
吞咽功能障碍	是	-0.12(-1.37~0.92)	0.19(-0.31~0.80)
	否	-0.29(-1.16~0.05)	-0.01(-0.25~0.24)
癫痫	是	-0.30(-1.88~0.54)	0.15(-0.14~0.45)
	否	-0.34(-1.24~-0.04)^*	0.09(-0.15~0.38)
总体		-0.32(-1.06~-0.15)^*	0.06(-0.15~0.28)
注：^* P < 0.05。

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