脊柱结核伴截瘫所致骨质疏松的骨代谢特点及临床意义  

The characteristics of bone metabolism in osteoporosis induced by spinal tuberculosis with paraplegia and its clinical sig- nificance

作　　者：王立民[1] 宫瑞[1] 武彦霄[1] 孙先泽[1] 

机构地区：[1]河北省石家庄市第三医院脊柱外科,050011

出　　处：《中国防痨杂志》2016年第4期266-269,共4页Chinese Journal of Antituberculosis

摘　　要：目的分析脊柱结核伴截瘫所致骨质疏松的骨代谢特点及临床意义。方法选取2010年1月至2015年6月石家庄市第三医院骨科住院治疗患者114例，根据病情分为脊柱结核伴截瘫组（38例）、外伤性脊柱骨折伴截瘫组（38例）、脊柱结核不伴截瘫组（38例），并且选取同期在我院体检中心查体的健康志愿者作为对照组（38名）。收集研究对象的临床信息，对比分析各组骨密度、骨代谢指标、血清25-羟维生素D及血清钙水平等指标的差异。结果脊柱结核伴截瘫组患者的左侧股骨颈骨密度（0．6149±0．0929）g／cm2，低于外伤性脊柱骨折伴截瘫组[（o．7062±0．0917）g／crnz]、脊柱结核不伴截瘫组[（0．7781±0．0924）g／cm2]及对照组E（0．8914±0．0816）g／cm2]，差异有统计学意义（F=30．44，P=0．000）；破骨细胞标志物血清J}胶原降解产物水平[（0．77±0．10）μg／L]高于外伤性脊柱骨折伴截瘫组[（0．68±0．11）ug／L]、脊柱结核不伴截瘫组[（0．61±0．11）μg／L]及对照组[（0．38±0．10）〉g／L]，差异有统计学意义（F=66．94，P=0．000）；血清25一羟维生素D水平[（41.38±11.73）nmol／L]明显低于外伤性脊柱骨折伴截瘫组[（60．03±11．10）nmol／L]、脊柱结核不伴截瘫组[（57．88±11．45）nmol／L]及对照组[（71．30±26．98）nmol／L]，差异有统计学意义（F=9．77，P=0．000）。脊柱结核伴截瘫组、外伤性脊柱骨折伴截瘫组、脊柱结核不伴截瘫组、对照组的血清钙含量分别为（2．31±0．13）mmol／L、（2．28±0．15）mmol／L、（2．29±0．09）mmol／L、（2．32±0．13）mmol／L，差异无统计学意义（F=O．34，P=0．713）。结论脊柱结核伴截瘫患者骨密度急剧下降，破骨细胞活跃，血清25-羟维生素D水平降低，在临床中需应用抑制破骨细胞活性的药物，强化维生素D、钙剂的摄入。Objective To analyze the characteristics of bone metabolism in osteoporosis induced by spinal tuberculosis with paraplegia and its clinical significance. Methods One hundred and fourteen patients admitted in the Third Hospital of Shijiazhuang City were enrolled and divided into three groups according to the diagnosis, including spinal tuberculosis with paraplegia group （n= 38）, traumatic spinal fractures with paraplegia group （n= 38） and spinaI tuberculosis without paraplegia group （n=38）. And 38 participants of control group were healthy volunteers from physical examination center of our hospital in the same period. All data of clinical information were collected. The Bone mineral density （BMD）, serum bone metabolism markers, 25（OH）VD and total calcium levels among the groups were compared. Results The BMD of left femoral neck bone in spinal tuberculosis with paraplegia group （（0. 6149± 0. 0929） g/cm2） were significant lower than those of traumatic spinal fractures with paraplegia group （（0. 7062±0. 0917） g/cm2 ）, spinal tuberculosis without paraplegia group （（0. 7781± 0. 0924） g/cm2 ） and the control group （（0. 8914±0. 0816） g/cm2 ） （F= 30.44, P= 0. 000）. The a-CTX levels of spinal tuberculosis with paraplegia group （（0. 77 ±0. 10） μg/L） were significant higher than those of traumatic spinal fractures with paraplegia group （（0.68±0.11） μg/L）, spinal tuberculosis without paraplegia group （（0.61±0.11） μg/L） and the control group （（0.38±0.10） μg/L）（F=66.94,P=0. 000）. In addition, the 25（OH）VD levels of spinal tuberculosis with paraplegia group （（41.38±11.73）nmol/L） were significant lower than those of traumatic spinal fractures with paraplegia group （（60.03±11.10） nmol/L）, spinal tuberculosis without paraplegia group （（57.88±11.45） nmol/L） and the control group （（71.30± 26.98） nmol/L）（F= 9.77,P=0. 000）. The differences of the levels of serum total calcium among spinal

关 键 词：结核 脊柱 截瘫 骨密度 骨代谢 

分 类 号：R683.2[医药卫生—骨科学]