重视慢性阻塞性肺疾病相关的骨质疏松症：病例和文献复习

Attention to chronic obstructive pulmonary disease accompanied with osteoporosis： cases report and literature re- view

目的重视和提高慢性阻塞性肺疾病（COPD）相关的骨质疏松症早期诊断及防治意识。方法报道2例COPD相关的骨质疏松症并文献复习。结果2例COPD患者均已出现明显骨质疏松症表现，但因医务人员相关意识不足而多次误诊。结合病例复习文献，肺功能损害程度与骨质疏松症的发生以及疾病的严重程度呈正比，COPD患者合并股骨颈部和椎体的骨质疏松症是对照组的5倍。COPD往往有肺通气障碍，如伴有呼吸性酸中毒时可加速骨组织中的钙释放到循环血液中，此外COPD和骨质疏松症具有相同患病因素，如吸烟、糖皮质激素的应用、低体质量、营养不良、活动减少等，使COPD患者骨质疏松症的发病年龄明显提前。结论对COPD合并骨质疏松症早期诊断和干预，对于其活动能力的保持和生活质量的提高，乃至延缓死亡等具有重要意义。

Objective To pay attention to and strengthen awareness of early diagnosis and preventive control of oste- oporosis relevant to chronic obstructive pulmonary disease （COPD）. Methods Cases of COPD accompanied with oste- oporosis was reported and literature was reviewed. Results Two typical cases of COPD accompanied with osteoporosis were misdiagnosed due to not conscious of it. As literature reviewed, the severity of lung function damage bore proportion to osteoporosis. The rate of osteoporosis of hip and vertebral column in patients with COPD had five times than that of control groups. Patients with COPD suffer from osteoporosis in the earlier age, because respiratory acidosis which patients with COPD usually suffer accelerates calcium release to circulation from bone tissue, besides COPD and osteoporosis had some same pathogenic factors, such as smoke, steroids, low body weight, malnutrition, immobility. Conclusion We should pay attention to osteoporosis relevant to COPD, and early diagnosis and prevention may be helpful to maintain and improve their mobility and quality of life, and even expectancy life.