双能X线吸收法对慢性乙型病毒性肝炎患者的骨密度评价

Evaluation of bone mineral density in patients with chronic hepatitis B by dual energy X-ray absorptiometry

目的比较慢性乙型病毒性肝炎(乙肝)患者和健康对照者之间骨密度的差异。方法采用双能X线吸收法,测定80例慢性乙肝患者和40名健康对照者的腰椎后前位(L1~L4)和总髋骨的骨密度值,同时采集研究对象的年龄、性别、肝肾功能、血清25-羟基维生素D等指标进行比较,并采用有序多分类Logistic回归分析影响骨密度下降的因素。结果慢性乙肝患者的腰椎骨密度值低于健康对照组(P<0.05)。单因素分析发现年龄增大、女性、血清ALT和AST水平升高、血清25-羟基维生素D水平下降、合并慢性乙肝等均增加骨质密度降低的风险。多因素Logistic回归分析发现年龄增大(OR=1.401,95%CI 1.179~1.665),女性(OR=1.438,95%CI 1.202~1.719),合并慢性乙肝(OR=1.389,95%CI 1.202~1.684)等均增加骨质密度降低的风险。结论慢性乙肝患者骨密度值较同性别、同年龄阶段的健康对照组降低,慢性HBV感染是骨密度水平下降的独立危险因素。

Objective To compare the bone mineral density （BMD） between chronic hepatitis B patients and healthy controls.Methods The BMD of the lumbar spine L1-L4 and total hip from 80 chronic hepatitis B patients and 40 healthy counterparts was assessed by dual energy X-ray absorptiometry.Other parameters including age, gender, liver and kidney function and serum level of 25-hydroxy-vitamin D were obtained.The risk factors of decreased BMD were identified by ordinal Logistic regression analysis.Results In the chronic hepatitis B patients, the BMD of lumbar spine was significantly lower than that in healthy controls（P〈0.05）.Univariate logistic regression analysis demonstrated that aging, female gender, alanine aminotransferase（ALT）,aspartate aminotransferase（AST）, declined serum level of 25-hydroxy-vitamin D level and chronic hepatitis B complication were the risk factors of lower BMD.Multivariate logistic regression analysis revealed that aging （OR=1.401, 95%CI 1.179-1.665）, female gender （OR=1.438,95% CI 1.202-1.719）, chronic hepatitis B complication （OR=1.389,95% CI 1.202-1.684） increased the risk of BMD reduction.Conclusions The BMD of chronic hepatitis B patients is lower compared with their healthy counterparts of the same gender and age.Chronic hepatitis B virus infection is an independent risk factor of decreased BMD.