老年男性慢性阻塞性肺疾病患者骨代谢与骨密度的关系  

Relationship between bone metabolism and bone mineral density in senile male patients with chronic obstructive pulmonary disease

作　　者：杨福荫[1] 刘法永[1] 戴丽[1] 李真[1] 薛延[2] 

机构地区：[1]北京积水潭医院内科,100035 [2]北京积水潭医院创伤骨科研究所

出　　处：《中华内分泌代谢杂志》2003年第2期125-128,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的　探讨老年男性慢性阻塞性肺疾病 (COPD)患者继发性骨代谢与骨密度 (BMD)变化的原因、临床特点及相互关系。方法　根据COPD肺功能诊断标准将 5 0例老年男性稳定期单纯COPD患者分为中度组和重度组 ,另设老年男性健康对照组 3 0例。检测并分析血气分析 ,BMD ,骨矿含量 (BMC) ,与骨吸收和骨形成有关的血、尿骨代谢生化指标的变化。结果　中、重度组患者的BMD和BMC较健康对照组明显降低 (P <0 .0 5或 0 .0 1) ,其中 ,重度组BMD、BMC的降低与氧分压降低明显相关 (r =0 .48～ 0 .5 3 ,P <0 .0 1)。骨吸收指标中尿钙 /肌酐比值明显升高 (P <0 .0 1) ;骨形成指标血清Ⅰ型前胶原羧基端前肽 ,碱性磷酸酶 ,骨钙素 ,2 5 (OH)D3 和雌二醇均明显升高 (P <0 .0 1或 0 .0 5 )。结论　根据WHO有关骨质疏松 (OP)诊断标准 ,多数老年男性COPD患者主要表现为骨量减低 ,很少发生OP ,这可能与机体代偿性对抗OP发生有关。其骨代谢特点与高转换Ⅰ型OP相似 ,与原发性老年男性Ⅱ型OP不同。治疗原发病 ,改善COPD患者缺氧状态可能是一种重要的防治方法。Objective To explore the cause, clinical characteristic and the relation to the alterations of bone metabolism and bone mineral density (BMD) in senile male patients with chronic obstructive pulmonary disease (COPD). Methods Fifty senile male patients with simple stable COPD were divided into moderate and severe groups based on the diagnostic criteria of pulmonary function. Thirty senile male health volunteers were considered as control group. Blood gas analysis, BMD, bone mineral content (BMC), biochemical indexes relative to the bone formation and bone absorption in blood and urine were measured and analyzed. Results Reductions in BMD and BMC were more significant in two COPD groups than those in control group (P<0.05 or 0.01), and manifested a significant correlation with PaO 2 decreasing in severe group (r=0.48～0.53,P<0.01). Ratio of urinary calcium and creatinine (Ca/Cr) reflecting bone resorption was significantly increased (P<0.05). Those indexes reflecting bone formation in the blood including carboxyl terminal propeptide of type Ⅰ procollagen, alkaline phosphataseandboneglaprotein(BGP),25(OH)D 3 and estradiol were significantly increased (P<0.05 or 0.01). Conclusion Based on WHO diagnosis criteria regarding osteoporosis (OP), most of senile male patients with COPD show predominantly BMD decreased, and do not suffer from OP, which suggests that the patients have compensatory mechanism anti-developing OP. Its characteristics of bone metabolism are different from those of the type Ⅱ of primary OP in senile male patients, but are similar to those of type Ⅰ OP (high osteo-turnover type). It is essential to treat underlying diseases and to improve anoxia for preventing and treating secondary OP occurring in senile male patients with COPD.

关 键 词：老年男性 慢性阻塞性肺疾病 骨代谢 骨密度 骨质疏松 

分 类 号：R563.9[医药卫生—呼吸系统]