【摘要】 目的回顾性分析原发性胆汁性肝硬化患者合并骨质疏松症的患病率并探讨其发病机制。方法选择2015年1月至2016年7月于首都医科大学附属北京地坛医院住院的原发性胆汁性肝硬化(primary biliarycholangitis,PBC)患者40例为PBC组,根据年龄和性别匹配无肝病对照组40例,比较两组患者骨密度(boneminaral density,BMD)、血清骨钙素(osteocalcin,OC)、总Ⅰ型胶原氨基端延长肽(total procollagen type 1 amino-terminal propeptide,P1NP)、Ⅰ型胶原降解产物(β-C-terminal telopeptide of typeⅠcollagen,β-CTX)和总25羟维生素D [25-hydroxy vitamin D,25(OH)VD]等指标以及PBC患者肝功能与BMD和骨代谢指标的关系。结果 PBC组患者合并骨密度异常34例(85.0%),其中骨量减少18例(45.0%),骨质疏松16例(40.0%);对照组患者合并骨密度异常11例(27.5%),其中骨量减少9例(22.5%),骨质疏松2例(5.0%),两组患者骨质疏松症患病率差异有统计学意义(χ~2=28.627,P=0.001)。PBC患者腰椎(L1～L4)和髋关节不同部位BMD均显著低于对照组(P均<0.001)。PBC患者中5例发生脆性骨折,其中1例先后发生腰椎骨折和左侧股骨颈骨折,对照组患者无脆性骨折发生。Child-Pugh C级患者BMD、血清骨钙素和总25-羟维生素D水平较Child-Pugh A级和B级患者低,但差异无统计学意义(P均> 0.05)。结论 PBC患者骨量减少和骨质疏松症患病率显著升高,其机制可能与血清骨钙素和总25羟维生素D水平下降有关。更多还原

【Abstract】 Objective To investigate the incidence and pathogenesis of osteoporosis in primary biliary cirrhosis(PBC) retrospectively. Methods Total of 40 cases with primary biliary cirrhosis in Beijing Ditan Hospital, Capital Medical University from January 2015 to July 2016 were enrolled as study group, and 40 cases with non-hepatopathy were matched according to age and sex as control group. The boneminaral density(BMD), serum osteocalcin(OC), total procollagen type 1 amino-terminal propeptide(P1 NP), β-C-terminal telopeptide of type Ⅰ collagen(β-CTX) and 25-hydroxy vitamin D [25(OH)VD] were compared between the two groups. The relationship between liver function, BMD and bone metabolism indexes in patients with PBC were also compared. Results Total of 34 cases(85.0%) in PBC group were complicated with abnormal bone mineral density, including 18 cases(45.0%) of bone loss and 16 cases(40.0%) of osteoporosis, while in control group, there were 11 cases with abnormal bone mineral density, including 9 cases(27.5%) of bone loss and 2 cases(22.5%) of osteoporosis, the difference of osteoporosis incidence between the two groups was statistically significant(χ~2 = 28.627,P = 0.001). The BMD of lumbar spine and hip of patients in PBC group were significantly lower than those in control group(P < 0.001). In PBC group, there were 5 patients with fractures, among whom one case developed subsequently lumbar fracture and left femoral neck fracture. There was no patient with fracture in control group. The BMD, serum osteocalcin and 25(OH)VD in PBC patients with Child-Pugh C grade were lower than those with Child-Pugh A and B grades, however, the differences were not statistically significant(P > 0.05). Conclusions The incidence of bone loss and osteoporosis in patients with PBC increased significantly. The mechanism may be related to the decrease of serum osteocalcin and 25-hydroxy vitamin D.更多还原