老年男性慢阻肺患者骨质疏松相关危险因素分析  

Study of risk factors related to bone metabolic biochemical markers and osteoporosis or osteopenia for elderly male with COPD

作　　者：李冬祎 王炜[2] 赵真[3] 陈颖[3] LI Dong-yi;WANG Wei;ZHAO Zhen;CHEN Ying(United Family Healthcare,Beijing 100015,China)

机构地区：[1]和睦家医疗,北京100015 [2]首都医科大学附属北京友谊医院检验科,北京100050 [3]首都医科大学附属北京友谊医院医疗保健中心,北京100050

出　　处：《临床肺科杂志》2019年第4期645-649,共5页Journal of Clinical Pulmonary Medicine

基　　金：北京市保健科研课题项目(编号:京17-16)

摘　　要：目的通过检测老年男性慢性阻塞性肺疾病(COPD)患者外周血甲状旁腺素(PTH)、骨钙素(OC)及25-羟维生素D3(25-OH-D3)水平,探讨老年男性COPD患者骨代谢的变化,并分析其发生骨质疏松及骨量减少的相关危险因素。方法纳入首都医科大学附属北京友谊医院轻中度老年男性COPD患者68例,重度极重度老年男性COPD患者37例,老年男性对照组55例,完善肺功能及骨密度检查,并使用全自动电化学发光分析仪检测外周血PTH、OC及(25-OH-D3)水平。结果①老年男性COPD患者出现骨量减少及骨质疏松的患病率为38.1%,高于正常对照组(P<0.05);②正常对照组、轻中度COPD组及重度极重度COPD组三组间外周血25-OH-D3水平依次为21.75±5.89、19.44±5.32及18.77±5.61(ng/mL),差异具统计学意义(P<0.05);三组间外周血PTH水平依次为39.54±14.63,44.85±14.24及47.48±15.96(pg/mL),差异具统计学意义(P<0.05);三组间外周血OC水平无明显差异(P>0.05)。③logistic回归分析结果显示肺功能FEV_1%(第一秒呼气量占预计值百分比)(OR=1.106)、体重指数(BMI)(OR=3.307)及外周血25-OH-D3水平(OR=1.641)是老年男性COPD患者出现骨质疏松及骨量减少的危险因素。结论老年男性COPD患者骨质疏松及骨量减少的发病率高于同龄健康男性;且存在外周血25-OH-D3减低及PTH升高;肺功能FEV_1%减低、体重指数下降及外周血25-OH-D3水平减低是引起老年COPD患者出现骨质疏松及骨量减少的可能原因。Objective To discuss bone metabolic change and analyze risk factors of developing osteoporosisand osteopenia through detecting parathyroid hormone(PTH),osteocalcin(OC)and 25-hydroxyvitamin D3(25-OH-D3)level in peripheral blood(PB)of elderly male patients with chronic obstructive pulmonary disease(COPD).Methods It selected 68 male patients with mild-moderate COPD,37 male with severe COPD,and another 55 healthy male to complete pulmonary function and bone metabolic tests.The levels of PTH,OC and 25-OH-D3 in PB were detected and analyzed.Results 1.The morbidity of osteoporosis and osteopenia was 38.1% in the COPD group,which was higher than that of the control group(P<0.05).2.The level of 25-OH-D3 in PB of the control group,the mild-moderate COPD group and the severe COPD group were 21.75±5.89,19.44±5.32 and 18.77±5.61(ng/mL)respectively(P<0.05).The level of PTH in PB of the 3 groups were 39.54±14.63,44.85±14.24 and 47.48±15.96(pg/mL),respectively(P<0.05).3.Logistic regression model analysis showed tFEV1%(OR=1.106),body measurement index(BMI)(OR=3.307)and 25-OH-D3 level in PB(OR=1.641)were the risk factors for developing osteoporosis and osteopenia in elderly male COPD patients.Conclusion The morbidity of osteoporosis and osteopenia in elderly male COPD patients is increased,and PTH level increases and 25-OH-D3 level decreases in PB.The lower level of FEV1%,BMI and 25-OH-D3 in PB may lead to osteoporosis and osteopenia in elderly male COPD patients.

关 键 词：慢性阻塞性肺疾病 骨质疏松 骨量减少 25-羟维生素D3 甲状旁腺素 骨钙素 

分 类 号：R580[医药卫生—内分泌] R563.9[医药卫生—内科学]