老年人慢性阻塞性肺疾病病情分级与骨质疏松相关性分析

Study on the relation of disease classification and osteoporosis in patients with Chronic obstructive pulmonary disease

目的：研究老年人慢性阻塞性肺疾病病情分级与骨质疏松相关性，为继发性骨质疏松的防治提供理论依据。方法回顾分析126例老年COPD患者的病例资料，同期纳入50例非COPD患者作为对照组，所有纳入人员均进行进行肺功能及股骨颈、大转子、Ward区的骨密度测定，按FEV1水平将患者分为轻度肺功能损伤（n＝31）、中度肺功能损伤（n＝54）、重度肺功能损伤（n＝41），统计COPD与非COPD患者骨质疏松的发生率，比较不同肺功能损伤患者骨密度差异。结果126例COPD患者中共有45例患者出现骨质疏松，发生率为35．7％，22例骨量减少，发生率为17．5％，50例非COPD患者共有9例患者出现骨质疏松，比例为18％，COPD与非COPD的骨质疏松发生率差异有统计学意义（χ2＝5．281，P＜0．05）。轻度COPD、中度COPD、重度COPD、非COPD之间股骨颈骨密度分别为（0．74±0．11） g／cm、（0．66±0．08） g／cm、（0．56±0．05）g／cm、（0．94±0．10） g／cm，大转子骨密度分别为（0．71±0．12） g／cm、（0．63±0．07） g／cm、（0．56±0．05）g／cm、（0．95±0．08）g／cm，Ward区的骨密度分别为（0．88±0．14）g／cm、（0．72±0．10）g／cm、（0．61±0.07）g／cm、（0．96±0．09）g／cm，差异有统计学意义（F＝7．557、6．852、7．432，均P＜0．01）；COPD患者股骨颈、大转子、Ward区的骨密度明显小于非COPD，且肺功能损伤越重，骨密度越小。骨质疏松、骨量减少、骨密度正常患者FEV1％分别为（59．0±8．7）％、（77．7±7．6）％、（49．4±15．8）％， FVC％分别为（77．8±28.8）％、（88．9±38.4）％、（73．8±21．1）％，FEV1／FVC分别为（66．5±20．6）％、（59．8±24．2）％、（34．1±3．6）％，差异有统计学意义（F＝9．554，5．556，7．487，均P＜0．01）。结论老年COPD可继发骨质疏松，肺功能损伤程度与骨密度存在明显相关性，COPD患者应定期监测骨密度利于早期防治骨质疏松的发生、发展，有助于老年COPD患者肺功能的改善以及临床的治疗效果。

Objective To study the relation of disease classification and osteoporosis in patients with chronic obstructive pulmonary disease,and to provide a theoretical basis for secondary osteoporosis.Methods A retrospective analysis of clinical data of 126 patients with COPD from January 2012 to December 2014 was made.50 non-COPD patients were included as control group,the pulmonary function and BMD of the femoral neck,trochanter,Ward Dis-trict were detected.And according to FEV1 , all patients were divided into mild pulmonary dysfunction group （ n=31）,moderate pulmonary dysfunction group （n=54） and severe pulmonary dysfunction group （n=41）;the rate of osteoporosis were measured in COPD group and non-COPD group,the difference of BMD were compared in patients with different pulmonary injury.Results （ 1 ） There were 45 cases of osteoporosis in 126 patients with COPD, accounting for 35.7%, 22 cases of osteopenia, accounting for 17.5%.There were 9 cases of osteoporosis in 50 patients with non-COPD,accounting for 18%,the incidence of osteoporosis were statistically different in COPD group and non-COPD group,χ2 =5.281,P〈0.05.（2）The BMD of the femoral neck in mild COPD group,moderate COPD group,severe COPD group and non-COPD group were （0.74 ±0.11） g/cm,（0.66 ±0.08） g/cm,（0.56 ± 0.05）g/cm and （0.94 ±0.10） g/cm,the BMD of trochanter were respectively （0.71 ±0.12） g/cm,（0.63 ± 0.07）g/cm,（0.56 ±0.05）g/cm and （0.95 ±0.08）g/cm,the BMD of Ward District were （0.88 ±0.14）g/cm, （0.72 ±0.10）g/cm,（0.61 ±0.07）g/cm and （0.96 ±0.09）g/cm respectively,which were statistically significant （F=7.557,6.852,7.432,all P〈0.01）.The BMD of the femoral neck,trochanter,Ward District in COPD group were significantly less than non-COPD,and the more severe of pulmonary dysfunction,the more decreases of bone density.（3） The FEV1% in osteoporosis group,osteopenia group,normal BMD group were respectively （59.0 ±8.7）%,（77.7 ±7.6）% and （49.4 ±15.8）%;the FVC% were （77.8 ±28.8）%,（88.9 ±38.4）%,（73.8 ± 21.1）%;the FEV1/FVC were （66.5 ±20.6）%,（59.8 ±24.2）%,（34.1 ±3.6）%（F=9.554,5.556,7.487,all P〈0.01）,Conclusion There were a certain correlation between BMD and lung function.Osteoporosis is one of the extrapulmonary effects in elder COPD patients.So BMD should be regularly monitored for helping for early prevention and treatment of osteoporosis and development in osteoporosis,and improving lung function and clinical efficacy.