慢性阻塞性肺病与骨质疏松症的相关性研究

Relevance between chronic obstructive pulmonary disease and osteoporosis

目的 通过测定慢性阻塞性肺病 (COPD)患者骨密度、肺功能和骨代谢的变化 ,探讨COPD与骨质疏松症的相关性。 方法 用双能X线吸收测定仪 (DEXA)测定 88例男性COPD患者腰椎、股骨近端骨密度 (BMD) ,同时用肺功能仪测定肺功能 ,用酶联免疫法 (ELISA)测定血骨钙素 (BGP)、Ⅰ型前胶原C端肽 (PICP)、抗酒石酸盐酸性磷酸酶 (TRAP)、尿胶原吡啶并酚 (PyD)、脱氧胶原吡啶并酚 (D -PyD) ,并与对照组比较。 结果 COPD组的BMD值与对照组相比显著降低 (P <0 .0 1) ,TRAP ,PyD ,D-PyD显著升高 (P <0 .0 1)。COPD患者骨密度与用力肺活量 (FVC % )、一秒钟用力呼气量 (FEV1% )及一秒率 (FEV1/FVC % )均呈显著正相关 (P <0 .0 5 )。吸入激素患者与未吸入激素患者相比 ,BMD值无显著变化 ,但BGP降低 (P <0 .0 5 ) ,TRAP升高 (P <0 .0 5 )。 结论 COPD组骨密度低于对照组。COPD患者对骨代谢的影响表现为骨吸收增高 ,导致骨量丢失 ,引起骨质疏松。COPD患者吸入激素治疗组较不吸入激素组骨吸收指标升高 。

Objective To examine the relevance between chronic obstructive pulmonary disease (COPD) and osteoporosis by measurement of bone density (BMD), lung function and the biochemical markers of bone turnover in the male COPD patients. Methods BMD of 88 male patients with COPD was measured by dual energy X ray absorptiometry. Lung function was measured by lung function instrument. Serum osteocalcin(BGP), type Ⅰ procollagen C terminal piptide(PICP), tartrate resistant acid phosphatase(TRAP), urine pyridinoline(PyD) and deoxypyridinoline(D PyD) were measured by ELISA. The results were compared with those of 176 healthy men as controls. Results In COPD group, BMD levels were much lower than those in control(P<0.01), and TRAP, PyD, D PyD in COPD group were higher than those in control group(P< 0.01 ). BMD in COPD patients was positively correlated with FVC%, FEV1% and FEV1/FVC%(P<0.05). BMD in patients treated with inhaled steroids had no significant change, but TRAP level increased(P<0.05). Conclusion BMD in COPD patients were lower than that in controls. Bone resorption in patients with COPD is increased, causing reduction of BMD and tendency of osteoporosis.