Systemic Inflammatory Mediators and Bone Homeostasis in Intestinal Failure
Background: A proinflammatory state has been described in patients with intestinal failure. The prevalence of metabolic bone disease in this group is considerable. It is not known whether this proinflammatory state is related to bone parameters, though bone disease is recognized as a proinflammatory...
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Veröffentlicht in: | JPEN. Journal of parenteral and enteral nutrition 2007-03, Vol.31 (2), p.142-147 |
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Zusammenfassung: | Background: A proinflammatory state has been described in patients
with intestinal failure. The prevalence of metabolic bone disease in this
group is considerable. It is not known whether this proinflammatory state is
related to bone parameters, though bone disease is recognized as a
proinflammatory process in postmenopausal women. The purpose of this study was
to examine whether inflammation was related to bone disease. Methods:
Eight patients with parenteral nutrition (PN)-dependent intestinal failure but
no recent infections or immunosuppressive medications had serum assayed for
interleukin-6 (IL-6), tumor necrosis factor (TNF)-α, and its receptors
(TNFR-I and TNFR-II), C-reactive protein, and whole blood for lymphocyte
proliferation. Routine clinical laboratory measures of vitamin D, parathyroid
hormone, serum calcium, and phosphorus within 3 months of the inflammatory
measures were compared by Pearson's correlation to the inflammatory measures.
Results: Mean values for calcium, phosphorus, and albumin were
normal, but 25-hydroxy vitamin D was reduced and parathyroid hormone and
alkaline phosphatase elevated. Serum total calcium was negatively related to
TNFR-II, TNF-α and positively to T-helper cells. Longer PN dependence
was associated with inflammation and negatively with T-helper cells.
Conclusions: These preliminary findings are hypothesis generating
only but support an association of low calcium and longer duration of PN with
inflammation in patients with intestinal failure. Whether the inflammation
results from vitamin D deficiency or the vitamin D deficiency develops
secondary to excessive use of activated vitamin D to modulate inflammation
from some other cause, such as a component of PN or repeated infectious
challenge, requires further study.
Patients with intestinal failure have a proinflammatory state. Metabolic bone disease has high prevalence in patients with intestinal failure. The purpose of this study was to examine whether the proinflammatory state was related to bone disease. |
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ISSN: | 0148-6071 1941-2444 |
DOI: | 10.1177/0148607107031002142 |