炎症性肠病患者骨代谢状况评估  

Assessment of bone metabolism in patients with inflammatory bowel disease

作　　者：张文燕[1] 袁耀宗[1] 

机构地区：[1]交通大学医学院附属瑞金医院消化科,上海200025

出　　处：《中华消化杂志》2009年第7期437-441,共5页Chinese Journal of Digestion

摘　　要：目的了解炎症性肠病（IBD）患者骨代谢生化指标的变化特点，评估其与骨质疏松和（或）骨量减少间的关系，探寻IBD患者发生骨质疏松和（或）骨量减少的危险因素。方法选取2007年收治的IBD患者69例（IBD组，其中CD49例、UC20例）以及年龄、性别相匹配的20名体检健康人群（对照组）为研究对象，根据CD活动指数（AI）以及Truelove—Witts评分判定疾病活动度，酶联免疫分析法检测骨钙素（Oc）、25羟维生素D3[25（0H）D3]、Ⅰ型胶原交联氨基末端肽（NTX）等骨代谢相关指标水平，测定骨密度（BMD）及体重指数（BMI）。结果IBD组25-（OH）D。水平[CD2（44．45±39．38）nmol／L、UC：（34．67±23．79）nmol／L]较对照组[（98．42±25．84）nmol/L]显著降低（P〈O．05），NTX水平则显著升高[CD2（58．41±15．15）nmol BCE／mmol肌酐值、UC：（57．67±10．75）nmol BCE／mmol肌酐值、对照：（30．38±13．35）nmol BCE／mmol肌酐值，P〈0．01]。使用皮质类固醇激素者OC和25-（0H）D3水平[分别为（17．31±13．43）ng／ml和（26．99±9．12）nmol／L]较未使用皮质类固醇激素者[分别为（27．33±16．86）ng／ml和（45．33±39．03）nmol／L]显著降低（P〈0．05）。根据BMD检测结果，CD组和UC组骨质疏松发病率分别为7／49（14．3％）和3／20，骨量减少发病率分别为19／49（38．8％）和7／20，两组间差异均无统计学意义（P〉0．05）。使用皮质类固醇激素者腰椎T值（-1．19±0．93）较未使用者（-0．80±1．29）显著降低（P〈0．05），股骨颈T值两组间差异无统计学意义（P〉0．05）。高龄和低BMI是CD患者发生骨质疏松和（或）骨量减少的危险因素。结论IBD患者BMD显著降低，易发生骨质疏松，高龄和低BMI是CD患者发生骨质疏松和（或）骨量减少的危险因素。25-（OH）D3、NTX对评价IBD患者骨代谢状况有一定价值。Objective To assess the characteristics of biochemical parameters of bone metabolism in patients with inflammatory bowel disease （IBD） and the relationship between osteoporosis and the reduction of bone mass so as to identify the risk factors for osteoporosis in IBD. Methods Sixty-nine patients with IBD [49 with Crohn disease （CD） and 20 with ulcerative colitis （UC）] and 20 sex- and age-matched healthy subjects （control group） from the medical examination centre in 2007 were enrolled in the study. The disease activity was estimated according to CD active index and Truelove-Witts score. The biochemical markers of bone metabolism including ostecalcin （OC）, 25-hydroxycholecalciferol [25 （OH） D3 ] and cross-linked N-telopeptides of type Ⅰ collagen （NTX） were tested using enzyme immunoassay. The body mass index （BMI） and bone mineral density （BMD） were also measured. Results The concentration of 25（OH）D3 was significantly lower in both CD [（44.45±39.38） nmol/L] and UC patients [ （34. 67±23. 79） nmol/L] compared with controls [（98.42±25.84） nmol/L] （P d0.05）, while NTX level was significantly higher in both CD [（58. 41±15.15） nrnol BCE/mmol Cr] and UC E（57. 67± 10. 75） nmol BCE/mmol Cr] patients compared with controls [（30. 38±13. 35） nmol BCE/mmol Cr] （P〈0.05）. The levels of OC and 25 （OH）D3 in patients treated with steroids [（17. 31 ± 13. 43） ng/ml and （26. 99 ± 9. 12） nmol/L, respectively] were lower than those in patients untreated with steroids [（27.33 ± 16.86） ng/ml and （45.33±39.03） nmol/L,respectively]. BMD examination revealed that the incidence of osteoporosis in CD or UC groups were 14.3%（7/49） or 3/20, respectively, with no difference between two groups （P〉0. 05）. The T score of lumbar spine in patients treated with steroids （-1.19±0. 93） was significantly lower than that in patients untreated with steroids （-0.80±1.29） （P〈0.05）, but there was no difference in T score of femora

关 键 词：克罗恩病 结肠炎 溃疡性 骨质疏松 

分 类 号：R686[医药卫生—骨科学]