Bone density, body composition, and inflammatory status in cystic fibrosis

被引:129
作者
Ionescu, AA
Nixon, LS
Evans, WD
Stone, MD
Lewis-Jenkins, V
Chatham, K
Shale, DJ
机构
[1] Cardiff Univ, Sect Resp Med, Penarth, S Glam, Wales
[2] Univ Wales Hosp, Acad Ctr, Bone Res Unit, Penarth, S Glam, Wales
[3] Llandough Hosp NHS Trust, Penarth, S Glam, Wales
[4] Univ Wales Hosp, Dept Med Phys & Clin Engn, Cardiff CF4 4XW, S Glam, Wales
[5] Llandough Hosp NHS Trust, Cardiff, S Glam, Wales
关键词
D O I
10.1164/ajrccm.162.3.9910118
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Low body weight and loss of bone mass are major problems in adults with cystic fibrosis (CF) and chronic pulmonary infection. Although these complications probably have a multifactorial origin, we hypothesized that the continuous acute-phase inflammatory and catabolic state may contribute. We determined body composition, bone turnover, physical activity, and circulating interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and their soluble receptors in 22 adults with CF and 22 age- and sex-matched healthy subjects. Comparisons were also made within patients before and after treatment of an exacerbation of respiratory symptoms. The patients had a lower mean (95% confidence interval [CI]) fat-free mass (FFM) 39.9 (36.3, 43.6) kg than healthy subjects, 49.4 (45.1, 53.7) kg, p < 0.05. The patients were in negative nitrogen balance and 20 had bone mineral density (BMD) Z scores less than or equal to 2.5 SD (n = 13) or less than or equal to 1 SD (n = 7) at least at one site. They had increased bone collagen breakdown, greatest in those with a reduced FFM. BMD was related to FEV1 (r = 0.44), IL-6 (r = -0.60), and TNF-alpha-soluble receptors (r = -0.42, r = -0.50). Patients with a low FFM had greater concentrations of IL-6, which suppressed less after antibiotic treatment than in those with a normal FFM. Those with a low FFM were more catabolic and less active than those with a normal FFM. The association between altered body composition, catabolic status, and circulating inflammatory mediators suggests that chronic pulmonary infection in adults with CF may be a contributory factor in the long-term complications of low weight and bone disease.
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页码:789 / 794
页数:6
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