病毒性肝炎肝硬化患者骨质疏松症的临床研究

Clinical study of osteoporosis in patients with cirrhosis after viral hepatitis

目的观察病毒性肝炎肝硬化患者骨质疏松发生率,并初步探讨其发病机制。方法 2008年10月至2010年9月间房山区第一医院消化科门诊及住院的病毒性肝炎肝硬化患者50例,对照组50例,进行骨密度、血清钙(Ca)、磷(P)、甲状旁腺素(PTH)检测。结果肝硬化组骨质疏松发生率64.0%(32/50),显著高于对照组20.0%(10/50),差异有统计学意义(P<0.05)。在Child-Pugh C级患者尤著(90.9%)。肝硬化组的骨密度(0.693±0.556vs 0.844±0.372g/cm2)、血Ca较对照组降低(1.92±0.35vs2.32±0.12 mmol/l),血清PTH水平高于对照组(29.8±12.3vs25.6±12.2 pmol/l),差异有统计学意义,P<0.05。随着肝功能损害的加重,肝硬化患者的骨密度、血Ca逐步下降,血PTH水平逐步升高,其中,与Child A、B级相比,Child C级患者骨密度、血Ca、血PTH水平,差异有统计学意义,P<0.05。肝硬化患者骨密度与血钙呈正相关,P<0.05。结论病毒性肝炎肝硬化患者骨质疏松发生率明显升高,并随着肝功能损害的加重,发生率逐步升高,其机制可能与血Ca下降、血PTH水平升高有关。

Objective To observe the incidence of osteoporosis in patients with cirrhosis after hepatitis, and to investigate its pathogenesis. Methods Fifty patients with cirrhosis after viral hepatitis, who came to outpatient department or hospitalized in the Department of Gastroenterology in the First Hospital of Beijing Fangshan District from October 2008 to September 2010, were enrolled. Fifty healthy subjects were selected as control group. Bone mineral density （ BMD）, serum calcium, phosphorus, and parathyroid hormone （PTH） were measured in both groups. Results The incidence of osteoporosis in cirrhosis group was 64.0% （32/50）, which was significantly higher than that in control group （20. 0%, 10/50）. The difference was significant （P 〈 0.05 ）. The incidence of osteoporosis was up to 90. 9% in patients graded as Child-Pugh C class. BMD and serum calcium in cirrhosis group was lower than that in control group （0. 693 ±0. 556 g,/em2 vs 0. 844 ±0. 372g/cm2 ; 1.92 ±0. 35 mmol/L vs. 2.32 ± 0.12 mmol/L, respectively） , whereas the level of PTH in cirrhosis group was higher than that in control group （29.8 ± 12.3 pmol/L vs. 25.6± 12.2 pmol/L） , and the difference was significant （ P 〈 0. 05 ）. With the aggravation of impaired liver function, BMD and serum calcium in patients with cirrhosis gradually declined, whereas serum PTH level gradually increased. BMD, serum calcium, and PTH level in Child A and B class patients were statistically different （P 〈 0. 05） compared to those in Child C class patients. BMD of patients with cirrhosis was positively correlated with serum calcium level （P 〈 0.05）. Conclusion The incidence of osteoporosis is significantly increased in patients with cirrhosis after hepatitis. And the incidence gradually increases along with the aggravation of impaired liver function. The mechanism may have relationship with decreased serum calcium level and elevated serum PTH level.