老年帕金森病患者骨质疏松危险因素分析

Risk factors of osteoporosis in elderly patients with Parkinson’s disease

目的 探讨老年帕金森病(PD)合并骨质疏松(OP)患者的影响因素。方法 采用回顾性研究方法,选取2021年1月至12月江苏省人民医院老年PD门诊临床确诊的PD患者62例作为PD组,同期健康体检者69例为对照组,收集并比较两组间一般资料、血清25羟维生素D[25(OH)D]浓度及骨密度结果、统一帕金森病量表第三部分(UPDRSⅢ)及H-Y分期(Hoehn-Yahr)评分的差异。依据骨密度结果将PD患者分为股骨颈骨密度异常和腰椎骨密度异常组,并分析年龄、性别、病程、血清25(OH)D浓度及病情严重程度等因素和PD患者发生OP的相关性。结果 PD组患者血清25(OH)D浓度及骨密度低于对照组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄高(OR=1.091,P=0.011)、25(OH)D水平低(OR=1.412,P=0.027)是腰椎骨密度异常的独立危险因素;女性是股骨颈骨密度检查异常(OR=3.731,P=0.016)、腰椎骨密度检查异常(OR=7.989,P<0.01)的独立危险因素;高龄是PD患者发生两部位OP(OR=1.176,P=0.034)的危险因素;女性PD患者发生任一部位OP(OR=5.493,P=0.014)及两部位OP(OR=10.837,P=0.011)的风险均明显增加;25(OH)D减低仅和PD患者发生两部位OP的风险增高有关(OR=1.604,P=0.037)。结论 老年女性伴血清25(OH)D水平降低的PD患者更容易发生OP,腰椎骨密度监测可以作为预测PD并发OP的指标之一,且PD出现多部位OP患者以补充维生素D作为治疗首选。

Objective To investigate the influencing factors of senile Parkinson’s disease(PD) with osteoporosis(OP).Methods A retrospective analysis was made of 62 PD patients clinically diagnosed in the elderly PD outpatient department of Jiangsu Provincial People’s Hospital from January to December 2021 as the PD group,and 69 healthy people in the same period as the control group.The general data,serum 25 hydroxyvitamin D [25(OH)D] concentration and bone mineral density,the third part of the Unified Parkinson’s disease scale(UPDRSⅢ) and the score of H-Y stage(Hoehn-Yahr) were collected and compared between the two groups.According to the results of bone mineral density,PD patients were divided into two groups:abnormal femoral neck bone mineral density group and abnormal lumbar bone mineral density group.The correlation between age,sex,course of disease,serum 25(OH)D concentration and severity of disease and OP in PD patients was analyzed.Results The serum 25(OH)D concentration and bone mineral density in PD group were lower than those in control group(P<0.05).Multivariate logistic regression analysis showed that old age(OR=1.091,P=0.011)and low 25(OH)D level(OR=1.412,P=0.027) were independent risk factors for abnormal lumbar bone mineral density;female was an independent risk factor for abnormal femoral neck density(OR=3.731,P=0.016)and abnormal lumbar bone density(OR=7.989,P<0.01);old age was the risk factor of two site op in PD patients(OR= 1.176,P= 0.034);the risk of OP at any site(OR= 5.493,P= 0.014) and two sites(OR= 10.837,P=0.011) was significantly increased in female PD patients;the decrease of 25( OH) D was only associated with the increased risk of OP at both sites in PD patients(OR= 1.604,P= 0.037).Conclusion Elderly women with reduced serum 25(OH)D levels are more likely to have OP.Lumbar bone mineral density monitoring can be used as one of the indicators to predict PD complicated with OP,and patients with multi site OP in PD should take vitamin D supplementation as the first choice for treatment.