肺结核患者骨代谢特点及骨质疏松发生风险分析

Characteristics of bone metabolism and risk analysis of osteoporosis in patients with pulmonary tuberculosis

目的研究肺结核患者骨代谢特点及骨质疏松风险,探讨其临床意义。方法结核病初治患者146例作为观察组,以及健康体检者100例作为对照组。常规进行Ⅰ型前胶原N端肽(PINP)、β-胶原特殊序列(β-CTx)、骨钙素(OC)、血钙、血磷、25羟维生素D(25-OHD)及骨密度检测。结果观察组PINP、OC、25-OHD、血钙含量及骨密度T值显著低于对照组,β-CTx含量及骨质疏松比例显著高于对照组,差异有统计学意义(P <0. 05)。结核感染是骨质疏松的独立危险因素(HR=1. 82,P <0. 05),而年龄≥50岁、女性、慢性阻塞性肺疾病和哮喘则是导致结核患者出现骨质疏松的独立危险因素(HR值分别为6. 17、3. 29、1. 63、1. 68,P <0. 05)。观察组骨密度T值与PINP、OC均呈显著正相关,与β-CTx呈显著负相关(P <0. 05)。结论肺结核血清PINP及OC含量显著降低,β-CTx含量升高,可能与骨质疏松的易发有关。

Objective To investigate the characteristics of bone metabolism (BMD)and the risks of osteoporosis in patients with pulmonary tuberculosis.Methods Totally,146 cases of pulmonary tuberculosis with primary treatment were enrolled as the observation group,100healthy volunteers for physical examination were selected as control group.The concentration levels of serum PINP,β-CTx,OC,calcium,phosphorus,25-OHD and BMD were detected and analyzed.Results The concentra-tions of PINP,OC,serum calcium,25-OHD and BMD T score in observation group were lower than that in control group ;the β-CTx levels and incidence rate of osteoporosis in observation group were higher than that in control group,with the differences statistically significant (P <0.05).TB was an independent factor associated with incident osteoporotic (HR =1.82,P < 0.05);age≥50,female,asthma and COPD were independent risk factors for osteoporosis in TB patients (HR =6.17,HR = 3.29,HR =1.63,HR =1.68,P <0.05).BMD T score was positively correlated with PINP and OC,while negatively correlated with β-CTx in the observation group (P <0.05).Conclusion The concentration levels of PINP and OC significantly decreased,while β-CTx level increased in pulmonary tuberculosis patients,which may be relevant to the high incidence of osteoporosis.