慢性肝病患者合并骨质疏松症骨转换速率研究

Clinic study of bone turnover ratio from chronic liver disease patients with osteoporosis

目的探讨慢性肝病(Chronic liver disease,CLD)合并骨质疏松症(osteoporosis,OP)患者骨吸收和骨形成指标变化及其与骨转换速率的关系。方法受试者分为4组:CLD合并OP组(A组30例),CLD无OP组(B组32例),非CLD骨质疏松组(C组39例)和正常对照组(D组35例),观测各组骨形成指标:骨钙素(BGP)、骨特异性碱性磷酸酶(骨AKP)和股骨颈抗骨折能力(FS),同步检测骨吸收指标:尿吡啶醚(PYD)和脱氧吡啶醚(DPD)。结果A组患者血清BGP和骨AKP水平明显低于C组和D组,与C组比较,分别为(4.63±0.72)μg/L vs(5.84±1.44)μg/L(P<0.01)和(19.53±5.41)U/L vs(23.38±7.36)U/L(P<0.05);与B组比较:(4.63±0.72)μg/L vs(5.03±0.91)μg/L和(19.53±5.41)U/L vs(22.13±6.37)U/L(均P<0.05)。FS参数A组(0.43±0.01)P/cm2显著低于C组(0.48±0.04)P/cm2和B组(0.51±0.02)P/cm2(均P<0.05)。而尿PYD和DPD在A、B、C 3组之间差异无统计学意义;除FS、BGP外,所有指标参数A、B、C 3组都分别显著高于D组。结论慢性肝病并骨质疏松症患者骨形成减少大于骨吸收增多,相对绝经后骨质疏松症是一种低转换速率型骨质疏松。

Objective To discuss the relations between index change of bone absorption and formation and bone turnover ratio from chronic liver disease（CLD） patients with osteoporosis（OP）. Methods The subjects were divided into four groups： CLD with OP patients （group A,30 cases） and CLD without OP patients （group B, 32 cases）,non- CLD with OP patients （group C,39 casets） and healthy group （group D,35 cases）. The signals of the bone index were observed： bone osteocalin（BGP） and serum bone specific alkeliphosphatase（bone AKP）; and femoral neck strength （FS） which was measured by muscle evaluative system （MES）. The indicators of synchronization test of bone absorption were measured： urine pyridinolin（PYD） and deoxypyridinolino（DPD）. Results Serum BGP and bone AKP of group A were obviously lower than those of group C,respectived （4.63±0.72） μg/L vs （5.84±1.44） μg/L（ P 〈 0.01） and （19.53±5.41） U/L vs （23.38±7.36） U/L （ P 〈0.05）; The comparisons of the above items between group A and group B： were respectively （4.63 ± 0.72） μg/L vs （5.03 ± 0.91 ） μg/L and （19.53 ± 5.41 ） U/L vs （22.13±6. 37） U/L （all P 〈0.05）. FS level in group A （0.43-4-0.01） P/cm^2 vs （0.48±0. 04） P/cm^2 and （0.51± 0.02） P/cm^2 （all P 〈0.05）. But the difference between PYD and DPD level in urine was not significant. All the parameters among groups A,B and C were significantly higher than those in group D （all P 〈0.05） except for FS and BGP. Conclusion The decrease of bone formation is higher than the increase of bone absorption. OP is a kind of relative low turnover ratio type before postmenopausal.