骨代谢指标可用于评估炎症性肠病患者骨密度状况吗?

Can bone metabolic markers be used to assess bone mineral density status in inflammatory bowel disease patients?

目的探讨我国炎症性肠病(IBD)患者血清维生素D(VitD)和骨密度状况以及评估IBD患者骨密度状况的血清骨代谢指标。方法收集57例溃疡性结肠炎(UC)患者、52例克罗恩病(CD)患者及48例正常对照者的临床资料,检测所有受试者血清25-羟维生素D(25OHD3)、钙(Ca)、磷(P)、血清碱性磷酸酶(ALP)、Ⅰ型前胶原氨基端前肽(PINP)、β-Ⅰ型胶原羧基端肽(β-CTX),检测IBD患者骨密度。结果 UC组和CD组患者血清25OHD3水平较正常组分别下降27.88%和15.31%(P<0.001、P=0.047)。UC患者骨量减少和骨质疏松发病率分别为22.81%和3.51%,CD患者骨量减少和骨质疏松发病率分别为23.08%和3.85%。UC组、CD组和正常组间PINP、ALP、β-CTX差异无统计学意义(均P>0.05);IBD患者骨量正常组和骨量减少和(或)骨质疏松组差异无统计学意义(P>0.05);与25(OH)D3水平及骨密度均无明显相关性(P>0.05)。结论 IBD患者存在VitD缺乏,易出现骨量减少/骨质疏松,但血清骨代谢指标PINP、ALP、β-CTX并非评估和监测我国IBD患者骨密度状况的理想指标。

Objective To explore the serum vitamin D levels, bone mineral density status, and serum bone metabolic markers to asses bone mineral density （BMD） status in inflammatory bowel disease （IBD） patients.Methods A cohort of 57 ulcerative colitis （UC） patients, 52 Crohn＇s disease （CD） patients and 48 healthy controls. The serum levels of 25-hydroxyl vitamin D3（25OHD3）, calcium（Ca）, phosphorus（P）, alkaline phosphatase （ALP）, procollagen I N-terminal propeptide （PINP）, β-C-terminal cross-linked telopeptides of type I collagen （β-CTX） were detected. BMD were measured in IBD patients.Results Serum 25OHD3 levels of UC group and CD group decreased by 27.88% and 15.31% respectively compared with the healthy control group（P0.001 and 0.047）.The prevalence of osteopenia and osteoporosis in UC patients were 22.81% and 3.51%, and in CD patients were 23.08%, 3.85% respectively. PINP, ALP and β-CTX had no significant difference among the UC, CD and healthy control groups （P 0.05）; also no significant difference in BMD normal group and osteopenia / osteoporosis group of IBD patients, and did not correlate with 25OHD3 levels and BMD. Conclusion Chinese IBD patients prone to have deficiency of vitamin D and osteopenia / osteoporosis, but PINP, ALP and β-CTX were not the ideal bone metabolic markers to assess and monitor BMD status in IBD patients.