克罗恩病合并严重骨质疏松症病例报道及文献复习

A Case Report and Literature Review of Crohn Disease Complicated With Severe Osteoporosis

目的:探讨克罗恩病(CD)合并严重骨质疏松症的机制、临床表现及诊治方法,以提高临床医师对本病的认识及诊治水平。方法:报道1例21岁女性患者,因发热、腹痛、腹泻、便血诊断为CD,使用糖皮质激素(GC)治疗半年,剂量相当于泼尼松15～50mg/d,患者逐渐出现双手关节、胸背及双侧肋骨疼痛,活动困难。行骨骼X光片检查及双能X线吸收法骨密度测量,并给予钙剂、活性维生素D、降钙素、骨吸收抑制剂帕米膦酸钠治疗,观察腰椎及髋部骨密度治疗前后的变化。结果:X光片示骨盆及胸腰椎明显骨质疏松,多椎体压缩性骨折。骨密度:L2-40.749g/cm2,Neck0.734g/cm2,Troch0.500g/cm2,Total0.658g/cm2,提示骨质疏松症。予抗骨质疏松联合治疗后,患者骨痛逐渐减轻,腰椎及髋部骨密度逐渐增加,活动能力明显提高。结论:接受GC治疗的炎症性肠病患者,易合并严重骨质疏松症,临床医师应重视并尽早防治此并发症。

Objective： To explore the mechanism, manifestation, diagnosis and treatment of Crohn disease （CD） complicated with severe osteoporosis in order to improve the understanding and recognization of the disease. Methods： A 21 year-old girl diagnosed as CD because of fever, abdominal pain, diarrhea and hematochezia was reported. After 6 months＇ glucocorticoid （GC） treatment （equal to dose of prednisone 15~50 mg）, serious pain occurred in joints of fingers, chest, back and ribs with difficulty of movement. X-ray films were taken and bone mineral density was measured by dual energy x-ray absorptiometry. Calcium, activated vitamin D, calcitonin and intravenous bi- sphosphonate were administrated. Changes of bone mineral density of the lumber and hip were observed before and after treatment. Results： X-ray films showed apparent osteoporosis at the pelvis and vertebra, and multi vertebral compression fracture. Measurement of bone mineral density revealed osteoporosis： L24 0. 749 g/cm2 , Neck 0. 734 g/ cm2 , Troch 0. 500 g/cm2 , Total 0. 658 g/cm2. The bone pain was relieved, bone density was increased gradually and activity was significantly improved after combination therapy against osteoporosis. Conclusions： Patients with in- flammatory bowel disease easy to complicating severe osteoporosis after treatment with GC, this complication should be paid attention and prevented as soon as possible by clinical physicians.