慢性肝病骨质疏松流行病学研究

Epidemiologic studies for osteoporosis in patients with chronic liver disease

目的调查慢性肝病患者骨质疏松的发生率,并与正常人群作对比研究。方法随机选取300例慢性乙型肝炎患者(95例不伴有肝硬化,205例伴有肝硬化,根据Child-Pugh分级:A级69例,B级62例,C级74例)作为试验组,选取年龄、性别、身高、体重相匹配的100例健康志愿者作为对照组。用GE公司生产的AchillesExpress跟骨超声骨密度测定仪,测定跟骨硬度指数(SI),对相关数据进行相应的统计学分析。结果慢性乙型肝炎组的跟骨SI(83.99±11.86)与对照组SI(98.73±13.19)比较有统计学差异(P<0.05)。肝硬化A组(93.78±12.60)、B组(80.26±11.38)、C组(69.84±10.01)患者SI值明显低于对照组SI(98.73±13.19)(P<0.001)。肝硬化A组(93.78±12.60)、B组(80.26±11.38)、C组(69.84±10.01)SI有明显降低趋势(P<0.01)。慢性乙型肝炎患者SI减少有年轻化的趋势,但是没有统计学意义。结论慢性乙型肝炎患者组SI较正常对照组明显减低。数据说明慢性乙型肝炎肝硬化的患者更容易出现合并骨质疏松,而且,骨质疏松患病率随肝硬化的严重程度逐步升高。

Objective To investigate the prevalence for osteoporosis in patients with chronic liver disease and in normal healthy people. Comparative study was done between the two groups. Methods Three hundred consecutive hepatitis B patients （95 with hepatitis B but no cirrhosis, 205 with cirrhosis, according to Child-Pugh classification：69 patients were Child-Pugh class A,62 were class B, and 74 was class C）were selected randomly as chronic hepatitis B patients group. One hundred normal healthy people were selected randomly matching with age, height and body weight as control group. The value of stiffness index （SI） of calcaneus was measured with Achilles Express ultrasound apparatus made in GE Company. All subjects were statistics analyzed. Results The SI（98.73 ＋ 13.19） of control group showed significantly higher than those chronic hepatitis B patients group（83.99 ± 11.86） （P 〈 0.05 ）. The value of SI of calcaneus in Child-Pugh group A （93.78 ± 12. 60）, group B （ 80. 26 ± 11.38 ）, group C （69. 84 ± 10. 01 ） showed significantly lower than control group. The SI of cirrhosis were significantly reduced from Child-Pugh group A （93.78 ± 12. 60）, group B （ 80. 26 ± 11.38 ） to group C （69. 84 ± 10. 01 ）. The SI of chronic hepatitis B patients group reduced tendency make more youthful, but the statistics analysis had no significant difference. Condusions The SI of normal healthy people control group showed signifieantly higher than those chronic hepatitis B patients group （P 〈 0.05 ）, the results showed that chronic hepatitis B patients were combined osteoporosis more easily. The prevalence of osteoporosis gradually increase with cirrhosis serious levels.