慢性阻塞性肺疾病并骨质疏松症患者血清RANKL、骨保护素水平的变化

Role of serum RANKL and osteoprotegerin in patients with chronic obstructive pulmonary disease complicated with osteoporosis

目的研究慢性阻塞性肺疾病(COPD)患者骨质疏松患病情况及OPG/RANK/RANKL系统在COPD骨代谢中的作用。方法选取2020年1月~2021年4月于我院就诊的稳定期慢性阻塞性肺疾病患者及按2∶1比例随机纳入同期健康体检者为研究对象。应用双能X线骨密度仪(DEXA)测定腰椎L1~L4及股骨颈的骨密度(BMD),根据骨密度将稳定期COPD患者分为骨质疏松组和非骨质疏松组,检测所有研究对象肺功能及入组当天血清核因子κB受体活化因子配体(RANKL)、骨保护素(OPG)水平并进行统计学分析。结果①COPD并发骨质疏松患病率为45.0%;②COPD骨质疏松组患者腰椎及股骨颈BMD随肺功能的下降而逐渐减低;③COPD骨质疏松组RANKL/OPG比值及血清RANKL水平明显高于非骨质疏松组,但OPG水平差异不显著。COPD骨质疏松组患者血清RANKL水平、RANKL/OPG比值随肺功能的下降而逐渐升高;④腰椎及股骨颈BMD与血清RANKL水平、RANKL/OPG比值呈负相关,与FEV_(1)(%)呈正相关,但与OPG水平无相关性。结论慢性阻塞性肺疾病容易继发骨质疏松,COPD骨代谢以骨吸收增强为主,OPG/RANK/RANKL系统在其中起着重要的作用。

Objective To investigated the prevalence of osteoporosis in patients with chronic obstructive pulmonary disease(COPD)and the role of OPG/RANK/RANK system in bone metabolism of COPD.Methods From January 2020 to April 2021,it selected stable COPD patients and healthy people who were randomly included during the same period at 2:1 ratio.Bone mineral density(BMD)of lumbar vertebrae L1-L4 and femoral neck were measured by dual-energy X-ray absorptiometry(DEXA).According to the BMD results,the stable COPD patients were divided into the osteoporotic group and the non-osteoporotic group.All subjects’lung function and serum receptor activator of nuclear factors-κB ligand(RANKL)and osteoprotectin(OPG)on the day of enrollment were measured.Results①The incidence of osteoporosis in COPD was 45%.②BMD of lumbar vertebrae and femoral neck decreased gradually with the decrease of lung function in COPD patients complicated with osteoporosis.③The level of serum RANKL and RANKL/OPG in the COPD osteoporosis group were significantly higher than those in the non-osteoporotic group,but there was no significant difference in OPG level.④BMD of lumbar vertebrae and femoral neck were negatively correlated with serum RANKL level and RANKL/OPG,and positively correlated with FEV_(1)(%),but had no correlation with OPG level.Conclusion There is a high incidence of osteoporosis in COPD patients.The main bone metabolism is increased bone resorbtion,and OPG/RANK/RANK system plays an important role in bone metabolism in COPD.