280例肝硬化患者中骨质疏松症发生情况回顾性分析

发布时间：2018-06-14 13:39

本文选题：肝硬化 + 骨质疏松症　；参考：《吉林大学》2017年硕士论文

【摘要】：背景和目的:骨质疏松症(osteoporosis,OP)是肝硬化患者的骨骼并发症,常无明显症状,如果不及时治疗,会增加骨折风险和影响患者的生活质量。近年来,国外研究表明,肝硬化是OP的危险因素,但肝硬化患者OP发生率报道各不相同,我国肝硬化患者较多,但目前国内关于肝硬化合并OP的发生率研究缺乏大样本数据。本研究旨在通过检测肝硬化患者骨密度(BMD)及25-羟维生素D[25(OH)D]水平,回顾性分析肝硬化患者合并OP的相关情况。方法:本研究终纳入2014年12月-2016年12月在吉林大学第一医院肝病科住院的肝硬化患者280例为研究对象,其中男性168例(60%),女性112例(40%),年龄在34-71岁,平均年龄在55.48±9.06岁。所有患者均采用双能X线吸收法检测腰椎(腰1-4)和股骨颈BMD水平,应用液相色谱-串联质谱法检测血清25(OH)D浓度。选择本院同期年龄、性别相匹配的非肝病住院患者280例为对照组。按照病因将研究对象分为原发性胆汁性肝硬化,即PBC组(40例)和非原发性胆汁性肝硬化组,即非PBC组(240例),其中非PBC组包括:乙肝肝硬化组(HBV组,110例),丙肝肝硬化组(HCV组,80例)、和酒精肝肝硬化组(ALD组,50例)。根据肝硬化严重程度,按照肝功能Child-Pugh分级A、B、C级将研究对象分为对应的A组、B组、C组。分析比较各组间BMD,25(OH)D水平及OP发生情况。结果:1、280例肝硬化患者中,共有61例发生OP,OP发生率21.79%(61/280);正常对照组280例,共有29例发生OP,OP发生率10.36%(29/280),肝硬化组的OP发生率明显高于对照组。肝硬化组腰椎BMD:L1-4,0.757±0.154(g/cm~2),股骨颈0.650±0.147(g/cm~2),分别明显低于正常对照组的0.988±0.145(g/cm~2),0.843±0.153(g/cm~2);肝硬化组25(OH)D水平17.89±12.88 ng/ml,明显低于对照组的28.01±11.89(ng/ml)(p0.001);肝硬化组与对照组BMD及25(OH)D水平均具有统计学差异。2、肝硬化组以Child-Pugh分级分组,将患者分为A、B、C三组。A组、B组、C组腰椎(L1-4)BMD分别为:0.843±0.169(g/cm~2),0.684±0.153(g/cm~2),0.597±0.161(g/cm~2);股骨颈BMD分别为:0.721±0.178(g/cm~2),0.587±0.166(g/cm~2),0.501±0.158(g/cm~2)。从A级到C级,患者BMD呈现下降趋势,且C级BMD水平明显低于A级。A组、B组、C组25(OH)D分别为20.89±11.79(ng/ml),19.24±11.93(ng/ml),12.49±9.21(ng/ml)。从A级到C级,25(OH)D逐渐下降,且C级25(OH)D水平明显低于A级。A-C组分别有11,29,21例发生OP,OP发生率分别为:14.10%,22.31%,29.17%,从A级到C级,OP发生率逐渐上升,C级OP发生率明显高于A级。3、40例PBC患者中,男性4例,女性36例,平均年龄:56.11±11.38岁。17例发生OP,OP发生率为:42.50%(17/40);240例非PBC组中,44例发生OP,OP发生率为18.33%(44/240),PBC组OP发生率显著高于非PBC组(p=0.001)。PBC组BMD:腰椎L1-4,0.505±0.148(g/cm~2),股骨颈0.424±0.132(g/cm~2),分别明显低于非PBC组的BMD:腰椎L1-4为0.799±0.149(g/cm~2)和股骨颈0.688±0.133(g/cm~2)。PBC组25(OH)D浓度为18.99±11.34(ng/ml),低于非PBC组的22.79±12.98(ng/ml),但两者无统计学差异。4、PBC组、HBV组、HCV组、AMD组腰椎(L1-4)BMD分别为:0.505±0.148(g/cm~2)、0.758±0.143(g/cm~2)、0.713±0.151(g/cm~2)、0.653±0.146(g/cm~2);股骨颈BMD分别为:0.424±0.132(g/cm~2)、0.724±0.136(g/cm~2)、0.690±0.157(g/cm~2)、0.613±0.168(g/cm~2),各组年龄差异均无统计学意义。经方差分析及两两比较,PBC组腰椎(L1-4)和股骨颈BMD均分别低于HBV组、HCV组和ALD组;而非PBC组内各组之间BMD均无明显差异(p0.05)。40例PBC患者中,17例发生OP,OP发生率为:42.50%(17/40);110例HBV肝硬化患者中,18例发生OP,发生率为16.36%(18/110);80例HCV肝硬化患者中,13例发生OP,OP发生率为16.25%(13/80);50例ALD患者中,13例发生OP,发生率为26.00%(13/50)。HBV组、HCV组、ALD组组间OP发生率无明显统计学差异;PBC组OP发生率高于其他肝硬化组,并且显著高于HBV组(p=0.001)、HCV组(p=0.002),与ALD组间无统计学差异(p=0.099)。结论:肝硬化患者的25(OH)D及骨密度水平明显降低,且均明显低于同龄非肝硬化对照组,骨质疏松症发生率明显高于对照组。肝硬化患者随着肝功能严重程度加重,骨质疏松发生率呈上升趋势。PBC肝硬化患者较非PBC肝硬化患者更易发生骨质疏松症。
[Abstract]:Background and purpose: Osteoporosis (OP) is a skeletal complication of patients with cirrhosis, which often has no obvious symptoms. If it is not treated in time, it will increase the risk of fracture and affect the quality of life of the patients. In recent years, foreign studies have shown that cirrhosis is a risk factor for OP, but the incidence of OP in patients with cirrhosis is different, and the liver hard in China is hard. There are more patients, but the current domestic study of the incidence of cirrhosis with OP lacks large sample data. This study aims to review the correlation of OP in cirrhosis patients by examining the bone mineral density (BMD) and 25- hydroxyvitamin D[25 (OH) D] levels in cirrhosis patients. Methods: This study was finally included in December -2016 year in Jilin in December 2014. 280 cases of liver cirrhosis hospitalized in the first hospital of the first hospital of the University were studied, including 168 (60%) men (60%), 112 women (40%), age 34-71, and the average age was 55.48 + 9.06 years. All patients were measured by double energy X-ray absorption method and the BMD level of the lumbar vertebra (waist 1-4) and femur neck, and the liquid chromatography tandem mass spectrometry was used to detect the serum 25 (OH) D 280 hospitalized patients with non liver disease matched by the same age in our hospital were selected as the control group. According to the cause, the subjects were divided into primary biliary cirrhosis, namely group PBC (40 cases) and non primary biliary cirrhosis group, that is, non PBC group (240 cases), and non PBC group included hepatitis B cirrhosis group (HBV group, 110 cases), hepatitis C liver cirrhosis group. (group HCV, 80 cases), and alcohol liver cirrhosis group (group ALD, 50 cases). According to the severity of liver cirrhosis, according to the liver function Child-Pugh classification A, B, C, the subjects were divided into A group, B group and C group. The BMD, 25 (OH) D level and occurrence of 1280 cases of liver cirrhosis were compared. 0): 280 cases in the normal control group, 29 cases were OP, and the incidence of OP was 10.36% (29/280). The incidence of OP in the cirrhosis group was significantly higher than that of the control group. The lumbar BMD:L1-4,0.757 + 0.154 (g/cm~2) and the femoral neck 0.650 + 0.147 (g/cm~2) were significantly lower than that of the normal control group, 0.988 + 0.145 (g/cm~2) and 0.843 + (g/cm~2), and the cirrhosis group 25 (OH) D water. The level of 17.89 + 12.88 ng/ml was significantly lower than that of the control group (28.01 + 11.89 (ng/ml)) (p0.001), and the levels of BMD and 25 (OH) D in the cirrhosis group and the control group were all statistically different in.2. The cirrhosis group was divided into Child-Pugh classification groups, and the patients were divided into A, B, C three group, 0.843 + 0.169, 0.684 + 0.153, 0.597 + 0., respectively. 161 (g/cm~2); the femoral neck BMD was 0.721 + 0.178 (g/cm~2), 0.587 + 0.166 (g/cm~2) and 0.501 + 0.158 (g/cm~2). From a to C, the patients' BMD showed a downward trend, and the BMD level of C level was significantly lower than that of class a.A group, B group, 20.89 + 11.79, 19.24 + 11.93, 12.49 +. The level of C 25 (OH) D was significantly lower than that of 11,29,21 in a class a.A-C group, and the occurrence rate of OP was 14.10%, 22.31%, 29.17% respectively. The incidence of OP increased gradually from a to C grade, and the OP incidence of C class was significantly higher than that of class A.3,40 cases, male 4, female 36, and average age: 56.11 + 11.38 years old. Of the 240 non PBC groups, 44 cases had OP, the incidence of OP was 18.33% (44/240), and the incidence of OP in PBC group was significantly higher than that in the non PBC group (p=0.001).PBC group BMD: lumbar L1-4,0.505 0.148 (g/cm~2), and the neck of the femur 0.424 + 0.132 (0.799 + 0.149) and femoral neck 0.688 + 0.133 respectively. The degree was 18.99 + 11.34 (ng/ml), which was lower than that of non PBC group (22.79 + 12.98), but there was no statistical difference between the two groups.4, PBC, HBV, HCV, and AMD group of lumbar vertebrae (L1-4) BMD were 0.505 + 0.148 (g/cm~2), 0.758 + 0.143 (g/cm~2), 0.713 + 0.151, 0.653 + 0.146, respectively. 0.157 (g/cm~2), 0.613 + 0.168 (g/cm~2), the age difference of each group was not statistically significant. After the analysis of variance and 22, the lumbar (L1-4) and the BMD of the femoral neck of group PBC were lower than the HBV group, HCV group and ALD group, while the BMD in non PBC group had no significant difference (P0.05) in the.40 cases, 17 cases were 42.50% (110); 110 The incidence of OP in 18 cases of HBV cirrhosis was 16.36% (18/110). Among 80 patients with HCV cirrhosis, 13 cases were OP, and the incidence of OP was 16.25% (13/80); 13 of the 50 ALD patients were OP (13/50).HBV group, and there was no significant difference between the HCV group and the group of cirrhosis. And significantly higher than group HBV (p=0.001), group HCV (p=0.002), and no statistical difference between group ALD (p=0.099). Conclusion: the level of 25 (OH) D and bone mineral density in patients with liver cirrhosis was significantly lower than that of non cirrhosis control group, and the incidence of osteoporosis was significantly higher than that of the control group. The severity of liver function increased with the severity of liver function in the patients with liver cirrhosis. The incidence of osteoporosis is increasing..PBC patients with cirrhosis are more prone to osteoporosis than non PBC cirrhosis patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2;R580

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