炎症性肠病患者骨密度降低的多因素分析

Factors associated with decreased bone mineral density in patients with inflammatory bowel disease

目的评估骨质疏松和（或）骨量减少在炎症性肠病（IBD）患者中的发生率，寻找IBD患者发生严重骨密度下降的主要因素，为临床尽早开展预防性治疗、及时诊断提供证据。方法选择66例IBD患者，其中克罗恩病（CD）38例，溃疡性结肠炎（UC）28例，测定患者骨密度，记录其主要症状、体征及实验室检查结果，制订治疗方案。根据CD活动指数（AI）和Truelove-Witts评分确定病情活动度。结果进行统计学分析。结果62例患者完成研究，平均年龄（40．9±15．4）岁。腰椎部出现骨质疏松和骨量减少者分别为21．0％和29．0％；股骨颈则分别为19．4％和6．5％，腰椎较股骨颈更易发生严重骨密度下降（P=0．005）。CD患者较UC患者更易发生骨质疏松和（或）骨量减少（P=0．001）。激素用量、体重指数的变化、病变范围、女性绝经和患者T值变化均相关。结论骨量减少与骨质疏松在IBD患者中普遍存在。年龄、激素、体重指数、病变范围、女性绝经和患者T值变化均相关。疾病活动度与骨密度下降是否存在联系尚待明确。

Objective To identify the prevalence and the risk factors of reduced bone mineral density （BMD） in patients with inflammatory bowel disease（IBD） and provide early diagnosis and treatment strategy. Methods Sixty-six IBD patients （38 with Crohn＇s disease, 28 with ulcerative colitis） were enrolled. The BMD was determined by dual-energy X ray absorptiometry （DXA） at the lumbar spine and the femoral articulation. T-score was obtained by comparison with sex-matched healthy young adults. The patient history, laboratory results were recorded, and the therapeutic protocol was made. The disease activities were determined by Crohn＇s disease active index and Truelove-Witts scores.： The results were analyzed. Results Sixty-two patients with average age of （40. 9 ± 15.4） years were analyzed. Osteoporosis or osteopenia at the lumbar spine were found in 21.0% or 29.0% of the patients, respectively. Osteoporosis or osteopenia at the femoral articulation were found in 6.5% or 19.4% of the patients, respectively. This indicated that osteoporosis or osteopenia were more frequent at the lumbar spine than at the femoral articulation （P = 0. 005）. Patients with Crohn＇s disease have higher susceptibility of osteoporosis/osteopenia than patients with ulcerative colitis （P = 0. 001）. Cumulative steroid dose, BMI, disease range and menopause were related with T-scores. BMD changes were not associated with gender, job, the severity of onset and smoking history. Conclusions Osteopenia and osteoporos!s are very common in IBD patients. Age, cumulative steroids, BMI, menopause are associated with T-score. It is not clear whether the disease activity is associated with bone density.