胃大部切除术对骨密度和生化指标的影响

Influence of partial gastrectomy on bone mineral density and biochemical parameters

鉴于有人提出胃切除术后会伴有骨代谢的改变，我们研究的目的就是评定经胃大部切除术（毕Ⅱ式）治疗的溃疡病患者的骨密度和骨代谢生化指标的变化。我们选择了３０名３０～６５岁的患者并与年龄、性别相配的以常规药物治疗的消化道溃疡组患者作对照。我们发现骨密度在患者组显著低于对照组，降钙素水平患者组亦显著低于对照组。但血清钙、磷、镁、骨钙素；尿钙、磷、镁在两组间没有显著差异。胃切除术引起骨质减少的机制仍需全面阐明。我们研究的结果表明胃大部切除术后椎骨密度有显著降低。生化指标没有变化。但降钙素明显降低。骨钙素水平有下降趋势，提示成骨细胞活动性减弱。降钙素水平的下降提示骨吸收的增加。

Objective:Since it has been suggested that gastrectomy is followed by changes in bone metabolism,the aim of our study was to determine the bone mineral density and the biochemical parameters of bone metabolismin patients with peptic ulcer treated by partial gastrectomy (Billroth Ⅱ).Methods:We studied the long-term effect of partial gastrectomy of bone metabolism. We selected 30 individuals between 30-65 years old and compared them with an age-and sex-matched group treated with drugs. Results: The bone mineral density in the patients was found significantly lower than that in the controls (P<0. 05). The levels of calcitonin in the patients was found significantly lower than in the controls. There were no significant differences between the two groups in levels of serum alkaline phosphatases,calcium,phosphorus,magnesium,osteocalcin and urine calcium,phosphorus and magnesium. Conclusions:The mechanism whereby gastrectomy results in osteopenia remains to be fully elucidated. The results of our study demonstrate significantly reduced vertebral mineral density in men following partial gastrectomy. In our study,the biochemical parameters did not show any changes but presented a significant reduction in calcitonin. Osteocalcin levels tended to be deficient sindicating reduced osteoblast activity. The decreased concentration of calcitonin probably suggests increase of bone resorption further evidences a high bone turnover rate as a possible cause of osteopenia in men after partial gastrectomy.