男性酒精性肝硬化患者骨量异常发生率及其肝功能分级与骨代谢指标的相关性研究  

Clinical study on osteoporosis in male patients with alcoholic cirrhosis

作　　者：刘楠[1] 高学松[1] 张耀南[2] 李洪杰[1] 张亦瑾[1] 高丽丽[1] 高萍[1] 刘亚平 段雪飞[1] Liu Nan;Gao Xuesong;Zhang Yaonan;Li Hongjie;Zhang Yijin;Gao Lili;Gao Ping;Liu Yaping;Duan Xuefei(Department of General Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Orthopedics,Beijing Hospital,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京地坛医院综合科,北京100015 [2]北京医院骨科,北京100730

出　　处：《中华全科医师杂志》2024年第7期709-715,共7页Chinese Journal of General Practitioners

基　　金：国家“十三五”传染病防治科技重大专项(2018ZX10715-005)。

摘　　要：目的分析男性酒精性肝硬化患者骨量异常发生率及其肝功能分级与骨代谢指标的相关性。方法该研究为回顾性研究。收集2017年3月至2023年7月于首都医科大学附属北京地坛医院住院的72例男性酒精性肝硬化患者为酒精性肝硬化组,根据年龄、BMI相匹配健康对照组40名,比较两组患者骨密度及骨质疏松发生率,比较不同Child-Pugh分级的酒精性肝硬化患者的骨密度及骨代谢指标血清骨钙素、总Ⅰ型胶原氨基端延长肽(TP1NP)、Ⅰ型胶原降解产物(β-CTX)和25羟维生素D[25-(OH)VD]等水平的差异及其相关性,采用有序多元logistic回归分析影响酒精性肝硬化患者Child-Pugh分级的骨代谢相关指标。结果酒精性肝硬化组72例患者中,骨量异常54例(75.0%),其中骨量减少21例(29.2%),骨质疏松33例(45.8%);对照组40名,骨量异常15例(37.5%),其中骨量减少9例(22.5%),骨质疏松6例(15.0%),两组患者发生骨量减少、骨质疏松的患者比例差异有统计学差异(χ^(2)=5.623、15.900,均P<0.05)。酒精性肝硬化组患者腰椎L1~L4椎体、股骨颈、转子间、股骨粗隆部位的骨密度水平均低于对照组(t=3.574、8.640、7.282、7.958、3.755、5.573、5.026,均P<0.05)。Child-Pugh C级酒精性肝硬化患者腰椎L1~L3、髋关节骨密度水平低于A级和B级患者(t=1.414、1.699、3.786、2.590,8.763、2.581、1.392、6.232,均P<0.05)。Child-Pugh C级患者25-(OH)VD水平低于A级和B级患者(t=3.969、2.911,P<0.05),血钙水平低于A级患者(t=3.627,P<0.05),TP1NP水平高于A级和B级患者(t=6.722、5.034,P<0.05)。Logistic回归分析显示结果显示,酒精性肝硬化患者TP1NP水平与Child-Pugh分级呈正向关联(β=2.186,P<0.05);25-(OH)VD水平与Child-Pugh分级呈负向关联(β=-0.767,P<0.05)。结论酒精性肝硬化患者骨量减少和骨质疏松症患病率显著升高,患者TP1NP水平、25-(OH)VD水平与Child-Pugh分级分别呈正向、呈负向关联。Objective To investigate the incidence of abnormal bone mineral density(BMD)in male patients with alcoholic cirrhosis.Methods Clinical data of 72 patients with alcoholic cirrhosis admitted in Beijing Ditan Hospital,Capital Medical University from March 2017 to July 2023 were enrolled as study group,and 40 age-and BMI-matched non-hepatopathy subjects were selected as control group.The incidence of abnormal BMD were compared between two groups.The serum levels of osteocalcin(OC),total procollagen type 1 amino-terminal propeptide(TP1NP),β-C-terminal telopeptide of type Ⅰ collagen(CTX)and 25-hydroxy vitamin D[25-(OH)VD]were measured and compared among patients with different Child-Pugh grades.Results Among 72 alcoholic cirrhosis patients,there were 54 cases(75.0%)complicated with abnormal BMD,including 21 cases(29.2%)of bone loss and 33 cases(45.8%)of osteoporosis.In control group there were 15 subjects with abnormal bone mineral density,including 9 cases(22.5%)of bone loss and 6 cases(15.0%)of osteoporosis(χ^(2)=5.623 and 15.900,both P<0.05).The average BMDs of L1-L4,femoral neck,intertrochanteric region and trochanter of the femur in patients with alcoholic cirrhosis were significantly lower than those in control group(t=3.574,8.640,7.282,7.958,3.755,5.573,5.026,all P<0.05);the average BWDs of L1-L3 and hip joint in patients with Child-Pugh C were significantly lower than those in patients with Child-Pugh A and B(t=1.414,1.699,3.786,2.590,8.763,2.581,1.392,6.232,all P<0.05).The serum levels of 25-(OH)VD in alcoholic cirrhosis patients with Child-Pugh C grade were significantly lower than those with Child-Pugh A and B(t=3.969 and 2.911,P<0.05);the serum calcium levels in patients with Child-Pugh C grade were lower than those with Child-Pugh A(t=3.627,P<0.05);while the TP1NP levels in patients with Child-Pugh C were higher than those with Child-Pugh A and B grades(t=6.722 and 5.034,P<0.05).The Child-Pugh grade was negatively correlated with 25-(OH)VD level(β=-0.767,P<0.05)and positively correlated with TP1NP lev

关 键 词：肝硬化 酒精性 骨密度 骨质疏松 

分 类 号：R575.2[医药卫生—消化系统]