老年慢性阻塞性肺疾病患者骨密度测定及影响因素分析

Determination of bone mineral density in aged patients with chronic obstructive pulmonary disease

目的探讨老年慢性阻塞性肺疾病（ＣＯＰＤ）患者骨质疏松的发生及有关影响因素。方法应用双能量Ｘ线吸光测定法测定ＣＯＰＤ组３９例患者及对照组１９例全身及局部的骨矿物含量，同时测定营养状态、血清钙、磷、碱性磷酸酶和肺功能。结果ＣＯＰＤ组体重、体重／理想体重％、上臂围、三头肌皮皱厚度、臂肌围、第２、３、４腰椎（Ｌ２～４）及左股骨Ｗａｒｄ＇ｓ区骨密度水平均显著低于对照组（Ｐ＜０．０５）。ＣＯＰＤ组Ｌ２～４和左股骨Ｗａｒｄ＇ｓ区骨质疏松发生率显著高于对照组（Ｐ＜０．０５）。Ｌ２～４和左股骨Ｗａｒｄ＇ｓ区骨密度均与体重、体重／理想体重％、上臂围、三头肌皮皱厚度、臂肌围呈显著正相关（Ｐ＜０．０５）。左股骨Ｗａｒｄ＇ｓ区骨密度与用力肺活量（ＦＶＣ％）、一秒钟用力呼气量（ＦＥＶ１％）及一秒率（ＦＥＶ１／ＦＶＣ％）均呈显著正相关（Ｐ＜０．０５）。结论老年ＣＯＰＤ组骨质疏松发生率高于同年龄对照组。营养状态、肺功能指标为影响ＣＯＰＤ患者骨密度的相关因素。

Objective To evaluate the incidence of osteoporosis and correlative factors in aged patients with chronic obstructive pulmonary disease(COPD). Methods Bone mineral densities(BMD) of whole body and regional sections were measured by dual energy X ray absorptiometry(DEXA) in 39 aged patients with COPD and 19 control subjects. Results The body weight, body weight/ideal body weight%,upper arm circumference, thickness of triceps skinfold, circumference of the arm muscle, BMD at L2 4 and left Ward's triangle in patients with COPD were significantly lower than those in controls ( P <0 05). The incidence of osteoporosis at L2 4 and left Ward's triangle in patients with COPD was significantly higher than that in controls ( P <0 05). BMD at L2 4 and left Ward's triangle had a positive correlation with the body weight, body weight/ideal body weight %,upper arm circumference, thickness of triceps skinfold, and circumference of the arm muscle ( P <0 05). BMD at the left Ward's triangle was positively correlated with FVC%,FEV 1% and FEV 1/FVC% ( P <0 05). Conclusions The incidence of osteoporosis in aged patients with COPD was higher than that in controls. BMD in patients with COPD is correlated with the nutritional state and lung function.