吸入糖皮质激素治疗对COPD患者的骨密度及骨折风险的影响  

Effect of inhaled corticosteroids on bone mineral density and fracture risk in patients with COPD

作　　者：李玉[1] 刘坤[2] 靳双周[1] LI Yu;LIU Kun;JIN Shuangzhou(Department of Respiratory,Jiaozuo People ’s Hospital,Jiaozuo 454000,Henan;Department of Orthopedics,Jiaozuo People ’s Hospital,Jiaozuo 454000,Henan,China)

机构地区：[1]焦作市人民医院呼吸科,河南焦作454000 [2]焦作市人民医院骨科,河南焦作454000

出　　处：《中国骨质疏松杂志》2019年第5期674-678,共5页Chinese Journal of Osteoporosis

摘　　要：目的观察吸入糖皮质激素治疗对慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者的骨密度及骨折风险的影响。方法 122例COPD患者,70例吸入糖皮质激素的当前使用者和52例从未接受过糖皮质激素治疗的患者,进行了骨密度(bone mineral density,BMD)和身体成分评估,并接受了椎体骨折评估(verterbral fracture assessment,VFA)。考虑用于分析的骨病的风险因素是年龄、性别、吸入糖皮质激素使用、体质量指数(body mass index,BMI)、肌肉质量指数(muscle mass index,MMI)和慢性阻塞性肺病全球倡议(GOLD)类别。同时还使用了针对汉族人群的骨折风险评估工具(FRAX)计算工具。结果这些组间在性别、BMI、MMI、GOLD等级、BMD T评分和Z评分的最低值,骨质疏松症的患病率或年龄的低BMD方面没有差异(P>0.05)。在使用吸入糖皮质激素的14例患者中通过VFA鉴定椎骨骨折,并且在没有接受糖皮质激素的患者中通过VFA鉴定椎体骨折(P<0.05)。MMI与骨质疏松症之间存在关联的趋势(P<0.05),并且根据通过GOLD评分评估的COPD严重性,BMD Z评分逐渐降低。椎体骨折与骨质疏松症(P>0.05)或低MMI(P>0.05)无关。FRAX没有估计骨折风险。结论吸入糖皮质激素可导致骨密度降低,但是骨折风险未发现增加。Objective To explore the effect of inhaled corticosteroids on bone mineral density, bone metabolism, and fracture risk in patients with chronic obstructive pulmonary disease(COPD). Methods A total of 122 COPD patients, 70 current users of inhaled glucocorticoids and 52 who had never received glucocorticoids, were evaluated for bone mineral density(BMD), body composition, and vertebral fracture assessment(VFA). The risk factors for bone diseases considered for analysis were age, gender, inhaled glucocorticoids use, body mass index(BMI), muscle mass index(MMI), and the Global Initiative for Chronic Obstructive Lung Disease(GOLD) category. The Fracture Risk Assessment Tool(FRAX) for the Han nationality was also employed. ResultsGender, BMI, MMI, GOLD class, the lowest values of the BMD T-score and Z-score, prevalence of osteoporosis, and low BMD for age were not different between the groups(P>0.05). Vertebral fractures were identified via VFA in 14 patients using inhaled corticosteroids and in none of those not receiving glucocorticoids(P<0.05). There was a trend for an association between MMI and osteoporosis(P<0.05) and for a progressive decrease in BMD Z-score according to the COPD severity assessed via the GOLD score(P>0.05), Vertebral fractures were not associated with osteoporosis(P>0.05) or low MMI(P>0.05). The fracture risk was not estimated by FRAX. Conclusion Inhaled corticosteroids causes a decrease in BMD, but no increase in fracture risk.

关 键 词：慢性阻塞性肺疾病 糖皮质激素 骨质疏松 骨密度 骨折 

分 类 号：R563.9[医药卫生—呼吸系统]