63例老年男性慢性阻塞性肺病患者骨密度和骨代谢的改变

Changes of bone density and bone turnover in 63elderly with chronic obstructive pulmonary disease

目的 通过测定慢性阻塞性肺病 ( COPD)患者骨密度和骨代谢的变化 ,探讨 COPD骨质疏松的发生机理。方法 应用双能 X线吸收测定仪 ( DEXA)对 63例老年男性 COPD患者进行腰椎、股骨近端骨密度 ( BMD)测定 ,酶联免疫法 ( ELISA)测定血骨钙素 ( BGP)、抗酒石酸盐酸性磷酸酸 ( TRAP)、I型前胶原 C端肽 ( PICP)、尿胶原吡啶并酚 ( Py D)、脱氧吡啶并酚 ( D- Py D) ,并与 30例老年男性对照组比较。结果 老年 COPD组的 BMD值与对照组相比显著降低 ( P<0 .0 1) ,TRAP、Py D、D- Py D显著升高( P<0 .0 1) ,有慢性呼衰患者的股骨近端 BMD较无慢性呼衰患者为低 ( P<0 .0 5 ) ,BGP也降低 ( P<0 .0 1)。吸入激素治疗患者与未吸入激素患者相比 ,BMD值无显著变化 ,但 BGP降低 ( P<0 .0 5 )、TRAP升高 ( P<0 .0 5 )。结论 COPD患者对骨代谢的影响为骨吸入增高 ,导致骨量丢失 ,引起骨质疏松。原因可能与 COPD患者缺氧、免疫、吸烟等因素有关。

Objective To examine the relationship between chronic obstructive pulmonary disease ( COPD) and osteoporosis by bone density ( BMD) measurewent and the biochemical markers of bone turnover in the elderly with COPD.Methods ( BMD) of 63male patients with COPD was measured by dual- energy X- ray absorptiometry. Serum osteocalcin ( BGP) ,tartrate- resistant acid phosphatase ( TRAP) ,type I procollagen C- terminal peptide( PICP) and urine pyridinoline( Py D) ,and deoxypyridi- noline( D- Py D) were measured by EL ISA.The results were compared with those of 30 healthy elderly men as controls.Results In COPD group,BMD levels were much lower than those in control( p<0 .1) , and TRAP,Py D,D- Py D in COPD group were higher than those in control group( p<0 .0 1) .BMD in femoral neck,Ward's triangle and serum BGP in COPD patients with chronic lung failure were lower than those in patients without chronic lung failure( p<0 .0 5 ) .BMD in patients treated with inhaled steroids had no significant change,but TRAP level increased( p<0 .0 5 ) .Conclusion Bone resorption in patients with COPD is increased,causing reduction of BMD and tendency of osteoporosis.The risk fac- tors may be hypoxia,smoking and use of steroids.