糖皮质激素性骨质疏松症骨代谢特征分析

Analysis of the characteristics of bone metabolism in glucocorticoid-induced osteoporosis

目的探讨糖皮质激素性骨质疏松症(glucocorticoid-induced osteoporosis,GIOP)患者的骨代谢特点,为继发性骨质疏松症鉴别诊断及GIOP治疗药物选择提供依据。方法选取2019年6月至2021年6月收住福建省立医院的研究对象共88例,分为GIOP组(48例)和正常对照组(40例)。收集两组一般临床资料、骨代谢生化指标、钙调激素及骨密度,分析两组间各项指标的差异有无统计学意义,分析GIOP组生化指标、钙调激素与骨代谢的相关性。结果GIOP组患者的骨形成指标总I型胶原氨基酸延长肽(tPINP)水平较正常对照组更低,具有显著性差异。GIOP组中,Pearson相关分析显示,tPINP分别与β-胶原特殊系列(r=0.509,P<0.01)、骨钙素(r=0.750,P<0.01)、磷(r=0.294,P<0.05)呈正相关;骨钙素分别与β-胶原特殊系列(r=0.524,P<0.01)、磷(r=0.403,P<0.01)呈正相关;甲状旁腺素与磷(r=-0.439,P<0.01)呈负相关。结论骨形成减少可能是GIOP的重要发病机制之一,选择促进成骨细胞活性或者抗成骨细胞凋亡药物可能会提高GIOP患者的疗效。

Objective To investigate the characteristics of bone metabolism in patients with glucocorticoid-induced osteoporosis(GIOP),and to provide evidence for the differential diagnosis of secondary osteoporosis and drug selection for GIOP treatment.Methods This study is a retrospective study.We selected 88 patients who visited our hospital from June 2019 to June 2021 as the research objects,who were divided into the GIOP group(48 cases)and the normal control group(40 cases).The general clinical data,biochemical indexes of bone metabolism,calcium-regulating hormones and bone mineral density were collected from the two groups.The difference of each index between the two groups was analyzed for statistical significance,and the correlation between each index was calculated.Results The level of total type I collagen amino acid extension peptide(tPINP)in the GIOP group was significantly lower than that in the normal control group.,and there was a significant difference.In the GIOP group,Pearson’s correlation analysis showed that tPINP was positively correlated with CTX(r=0.509,P<0.01),OG(r=0.750,P<0.01),and P(r=0.294,P<0.05),respectively;OG was positively correlated with CTX(r=0.524,P<0.01),P(r=0.403,P<0.01),respectively;PTH was negatively correlated with P(r=-0.439,P<0.01).Conclusion The reduction of bone formation may be one of the important pathogenesis of GIOP.Selecting drugs that promote osteoblast activity or anti-osteoblast apoptosis may improve the efficacy of patients with GIOP.