高龄男性慢性阻塞性肺疾病患者骨密度影响因素研究

Influential Factors of Bone Mineral Density in Older Male Patients with Chronic Obstructive Pulmonary Disease

目的探讨高龄男性慢性阻塞性肺疾病(COPD)患者的骨密度情况及相关影响因素。方法选择北京积水潭医院老年科2019年1月~2019年6月门诊或病房诊治的47例高龄男性COPD稳定期患者为研究对象。采集患者基本信息、血常规、生化、C反应蛋白(CRP)、血气分析、糖化血红蛋白、Vit D水平,腰椎、髋部骨密度测定及肺功能检查。结果 47例COPD患者平均年龄(84.89±5.21)岁,BMI (24.06±2.04) kg/m^2,有吸烟史者63.83%,吸烟指数平均417.02±60.06,戒烟比例87.2%,正在使用吸入激素的比例为17.02%;25 (OH) D3(11.723±5.60) ng/ml、CRP (6.15±3.330) mg/L;腰椎总体骨密度值为(1.393±0.256) g/cm^2,T值为0.862±0.192;髋部总体骨密度值为(0.950±0.198) g/cm^2,T值为-0.321±0.522;FEV1%(63.383±7.061)%,FEV1/FVC (57.021±7.078)%,DLCO%(71.511±5.247)%, FVC%(82.96±10.61)%, RV/TLC (58.787±7.014)%;血气分析PaCO2(39.264±3.792) mmHg,PaO2(76.017±9.446) mmHg;logistic回归分析以腰椎总体骨密度值为因变量分析得出BMI减低、CRP升高、Vit D缺乏、FVC%减低及DLCO%减低均为高龄COPD患者骨密度下降的独立危险因素;以髋部总体骨密度值为因变量分析得出增龄、吸入激素、白蛋白减低、Vit D缺乏、RV/TLC升高及DLCO%减低均为高龄COPD患者骨密度下降的独立危险因素。结论高龄男性COPD患者存在增龄、Vit D缺乏、营养状况不佳及激素使用等致骨密度减低的独立危险因素,临床上应做好早期筛查及诊治工作。与此同时稳定期CRP水平、阻塞性通气功能障碍及肺气肿严重程度、肺弥散功能均与其骨密度减低独立相关,提示COPD与骨代谢之间可能存在多途径的相互作用机制,有待进一步研究。

Objective To investigate the bone mineral density(BMD)and related influential factors in older male patients with chronic obstructive pulmonary disease(COPD).Methods 47 older male patients with stable COPD were selected in the Department of Geriatrics of Beijing Jishuitan Hospital from January 2019 to June 2019.The basic information,blood routine tests,c-reactive protein(CRP),blood gas analysis,glycosylated haemoglobin(HbA1c),25(OH)D 3 level,BMD of the lumbar spine and hip,and lung function were documented.Results The average age of 47 patients was(84.89±5.21)years old.Body mass index(BMI)was(24.06±2.04)kg/m 2.63.83%of the patients had smoking history,and the average smoking index was 417.02±60.06.The proportion of smoking cessation patients was 87.2%.The proportion of patients who were using inhaled corticosteroids was 17.02%.The levels of 25(OH)D 3 and CRP were(11.723±5.60)ng/ml and(6.15±3.33)mg/L respectively.The overall BMD of the lumbar spine was(1.393±0.256)g/cm 2,and T value was 0.862±0.192.The overall BMD of the hip was(0.950±0.198)g/cm 2,and T value was-0.321±0.522.FEV 1%was(63.383±7.061)%,FEV 1/FVC was(57.021±7.078)%,DLCO%was(71.511±5.247)%,FVC%was(82.96±10.61)%,and RV/TLC was(58.787±7.014)%.PaCO 2 was(39.264±3.792)mmHg,PO 2 was(76.017±9.446)mmHg.Logistic regression analysis showed that if the overall lumbar BMD was taken as the dependent variable,BMI reduction,CRP elevation,VitD deficiency,FVC%and DLCO%reduction were independent risk factors of lower BMD.If the overall hip BMD was taken as the dependent variable,aging,hormone inhalation,albumin decrease,VitD deficiency,RV/TLC increase and DLCO%decrease were independent risk factors of lower BMD in elderly patients with COPD.Conclusion Older male patients with COPD have independent risk factors for lower BMD,such as aging,VitD deficiency,poor nutritional status and hormone use,which should be screened,diagnosed and treated at early stage.At the same time,CRP levels during the stable period of COPD,obstructive ventilation dysfunction,emphysema severity,and lung diffuse function were independently associated with low BMD,suggesting that there may be multiple pathways of interaction between COPD and bone metabolism.