脊柱结核与骨量减低相关研究

Correlation between spine tuberculosis and bone mass

背景:脊柱结核是骨结核中最常见的类型。近年来,老年性脊柱结核的发病率逐渐升高,甚至伴发骨质疏松。而结核病是否会引起患者骨量减低的研究相对较少。目的:通过对脊柱结核患者和健康正常人群的骨密度及骨生化指标的分析比较,探讨脊柱结核与骨量减低的相关性。方法:本研究纳入110例脊柱结核患者和98例健康正常人。双光能X线骨密度仪测定正位腰椎(L2-L4)及左股骨颈、股骨大转子、Ward三角、整体髋的骨密度;电化学发光免疫分析法检测骨碱性磷酸酶(BAP)、骨钙素(BGP)、Ⅰ型胶原羧基端前肽(CTX)。结果:两组间性别、年龄差异无统计学意义(P>0.05)。脊柱结核组腰椎及左侧股骨颈、股骨大转子、Ward三角、整体髋骨密度低于对照组(P<0.05),且脊柱结核组骨量减少、骨质疏松发生率较对照组显著增高(P<0.05);在骨生化指标方面,脊柱结核组CTX水平高于对照组(P<0.05)。脊柱结核患者腰椎及左侧股骨颈、股骨大转子、Ward三角、整体髋骨密度与CTX水平呈负相关(P<0.05)。结论:脊柱结核可能会导致骨量减少,其发生与破骨细胞活性增强,促进骨吸收有关;骨质疏松预防性治疗可减少脊柱结核术后并发症的发生。

Background： Spinal tuberculosis is the most common type of bone tuberculosis. In recent years, the incidence of senile spinal tuberculosis has been gradually increasing, and sometimes associated with osteoporosis. There are few of researches about when spinal tuberculosis results in the increase of bone mass. Objective： The aim of the study is to compare bone density and bone biochemical markers between spinal tuberculosis patients and healthy volunteers and to explore the correlation between spinal tuberculosis and decreased bone mass. Methods： A total of 110 patients with spinal tuberculosis and 98 healthy volunteers were enrolled in the study. The bone mineral density （BMD） of lumbar spine （L3-L4）, left femoral neck, femoral greater trochanter, the Ward＇s triangle and total hip were detected by dual energy X-ray absorptiometry （DXA）. The levels of bone alkaline phosphatase （BAP）, bone gla protein （BGP） and collagen 1 carboxypropeptide （CTX） were determined by electrochemiluminescence immunoassay. Results： There were no significant differences in gender and age between two groups （P〉0.05）. The BMD of lumbar spine, left femoral neck, greater trochanter, Ward＇s triangle and total hip in spinal tuberculosis group were significantly lower than control group （P〈0.05）. The incidence of bone mass decrease and osteoporosis in spinal tuberculosis group were significantly higher than control group （P〈0.05）. The CTX level in spinal tuberculosis group was significantly higher than control group （P〈0.05）. In the spinal tuberculosis patients, CTX level was negatively correlated to the BMD of lumbar spine, left femoral neck, greater trochanter, Ward＇s triangle and total hip （P〈0.05）. Conclusions： Spinal tuberculosis may make bone mass decrease, which result from enhancing the activity of osteoclasts and bone resorption. Preventive treatment for osteoporosis may reduce the incidence of postoperative complications of spinal tuberculosis.