炎症性肠病患者的骨代谢和骨密度分析

发布时间：2018-02-08 14:55

  本文关键词： 炎症性肠病 骨质疏松 骨代谢 骨密度　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的炎症性肠病(inflammatory bowel disease, IBD)是一类病因尚未明确的慢性复发性肠道炎症性疾病,包括溃疡性结肠炎(ulcerative colitis, UC)和克罗恩病(Crohn's disease, CD)。近年来,IBD在我国的发病逐年上升,成为消化系统的常见疾病之一。越来越多的证据表明,IBD患者的骨质疏松发生率显著高于正常健康人群,IBD并发骨质疏松的相关研究也日益受到关注。了解IBD患者的骨代谢及骨密度情况,明确IBD并发骨质疏松的危险因素,将有助于IBD患者并发骨质疏松及骨折风险的早期预防和治疗。本研究通过分析IBD患者性别、年龄、体重指数(BMI)、病程、疾病活动度、病变部位、相关血清生物学指标及糖皮质激素应用等与骨质疏松发病的关系,探讨IBD患者骨密度减低的危险因素。方法以华东医院50例IBD患者为研究对象,以髋关节和股骨颈骨密度T值为评估骨密度情况的指标；采用独立样本t检验或卡方检验比较UC和CD患者之间骨代谢相关血清生物学指标、骨密度值及骨密度减低发生率的差异,比较骨密度减低者与骨量正常者之间的骨代谢指标、年龄、性别、病程等因素的差异；采用Spearman相关分析来分析骨代谢血清指标、年龄、BMI、病程与骨密度T值的相关性。采用logistic回归分析IBD患者骨密度减低的危险因素。应用统计学软件SPSS 19.0进行统计分析,P0.05表示差异有统计学意义。结果50例IBD(包括32例UC和18例CD)患者骨密度减低的发病率为70.0%,其中骨量减少者28例(56.0%),骨质疏松者7例(14.0%)。32例UC患者中,骨量减少者16例(50.0%),骨质疏松者6例(18.8%)；18例CD患者中,骨量减少12例(66.7%),骨质疏松1例(5.6%)；UC组和CD组骨密度情况差异无显著意义(x2=2.050,P=0.359)。15例骨量正常的IBD患者的平均年龄为(45.3±13.7)岁,35例骨密度减低者平均年龄为(57.1±14.8)岁,差异有显著意义(t=-2.627,P=0.012)。UC患者的年龄与髋关节T值(r=-0.457,P=-0.009)及股骨颈T值(r=-0.554,P=0.001)呈显著负相关。增龄是IBD患者骨密度减低的危险因素,但预测性较弱(OP=1.096,95% CI(1.022,1.176),P=0.010)。在28例骨量减少的IBD患者中,女性的平均年龄明显大于男性((63.0±10.7)岁vS.(46.9±12.4)岁,t=-3.593,P=0.001)。女性是IBD患者骨密度减低的保护因素(OR=0.074,95% CI (0.008,0.675),P=0.021)。骨密度减低的IBD患者的血清ALP水平显著高于骨量正常者((78.5±28.8) U/L vs. (62.2±16.7) U/L,t=2.037,p=0.047)。UC患者的血清ALP水平与髋关节T值(r=-0.431,P=0.014)、股骨颈T值(r=-0.437,P=O.012)均呈显著负相关。CD患者的血清ALP水平仅与股骨颈T值(r=-0.475,P=0.046)呈显著负相关。结论本院IBD患者骨密度减低的发病率较高。IBD中骨密度减低者的血清ALP水平显著高于骨量正常者；IBD患者血清ALP水平与骨密度值呈负相关；提示骨密度减低的IBD患者骨转换可能较活跃。UC患者年龄与骨密度T值呈显著负相关;年龄是IBD患者骨密度减低的独立危险因素。女性是IBD患者骨密度减低的保护因素。尚不明确体重指数、病程、疾病严重程度、病变部位、使用GCs以及血钙、血磷、25-(OH)D浓度与IBD患者骨密度的关系。
[Abstract]:The purpose of inflammatory bowel disease (inflammatory bowel, disease, IBD) is a kind of unknown etiology of chronic recurrent inflammatory bowel disease, including ulcerative colitis (ulcerative colitis, UC) and Crohn's disease (Crohn's disease, CD). In recent years, IBD incidence increased year by year in China, has become one of the common diseases of digestive system. More and more evidence that the incidence of osteoporosis in patients with IBD was significantly higher than that in normal healthy people, IBD related research of osteoporosis is also increasingly concerned. To understand the bone metabolism and bone density in patients with IBD, IBD and the risk factors of osteoporosis, there will be helpful to early prevention and treatment of IBD patients osteoporosis and fracture risk. Through the analysis of IBD patients with gender, age, body mass index (BMI), disease duration, disease activity, lesion, serum biological markers and glucocorticoid The relationship between hormone application and the incidence of osteoporosis, risk factors of bone mineral density in patients with IBD. Methods to reduce Huadong Hospital 50 cases of IBD patients as the research object, to evaluate the bone density index to hip and femoral neck BMD T value; by using independent sample t test or chi square test for comparison between UC and CD patients with bone metabolism of serum biochemical markers and bone mineral density, bone density to reduce the incidence of differences in bone metabolic markers, comparison between bone mineral density and bone mass reduction of normal age, gender differences, duration and other factors; using Spearman correlation analysis to analyze the serum bone metabolism index, age, duration of BMI, correlation bone mineral density and T value. The logistic regression analysis of risk factors of bone mineral density in patients with decreased IBD. SPSS 19 software was used for statistical analysis, P0.05 said the difference was statistically significant. Results 50 cases of IBD (including 32 渚婾C鍜，

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