中国骨质疏松杂志
中國骨質疏鬆雜誌
중국골질소송잡지
CHINESE JOURNAL OF OSTEOPOROSIS
2013年
11期
1177-1179
,共3页
肝硬化%肝癌%骨质疏松%骨密度%骨钙素
肝硬化%肝癌%骨質疏鬆%骨密度%骨鈣素
간경화%간암%골질소송%골밀도%골개소
Cirrhosis%Liver cancer%Osteoporosis%Bone mineral density%Osteocalcin
目的：观察肝硬化、肝癌患者骨质疏松的发生率探讨其发病机制。方法选择病毒性肝炎肝硬化患者40例、肝癌患者20例分别作为研究组，选择40例原发性骨质疏松和骨量减少患者作为对照组，采用双能X线吸收仪（ DXA ）检测骨密度（BMD），并检测骨代谢相关指标，采用放射免疫分析法测定血清骨钙素（BGP）、甲状旁腺激素（PTH）、血钙（Ca）、磷（P）。结果肝炎肝硬化患者中骨量减少及骨质疏松发生率为65％（26/40），肝癌组中骨质疏松发生率为70％（14/20），均明显高于对照组22.5％（9/40），差异有统计学意义（P＜0.05），在Child-Pugh C级患者更显著（90.9％）。肝硬化、肝癌组的BMD、Ca较对照组降低（1.90±0.33vs2.31±0.11 mmol/L），血清PTH水平明显高于对照组，有统计学意义P＜0.05。随着肝功能损害加重，肝硬化、肝癌患者的血Ca逐渐下降，血中PTH水平逐渐升高，BGP水平降低，骨形成减少，原发性骨质疏松不存在这种关系。肝硬化、肝癌患者的BMD与Ca呈正相关，（r＝0.483，P＜0.05）。结论肝硬化、肝癌患者骨质疏松发病率明显升高，且发病率随肝功能损害的逐渐加重而逐渐升高，其机理可能与血钙降低、维生素D、Ca、P的代谢紊乱及PTH升高有关。
目的：觀察肝硬化、肝癌患者骨質疏鬆的髮生率探討其髮病機製。方法選擇病毒性肝炎肝硬化患者40例、肝癌患者20例分彆作為研究組，選擇40例原髮性骨質疏鬆和骨量減少患者作為對照組，採用雙能X線吸收儀（ DXA ）檢測骨密度（BMD），併檢測骨代謝相關指標，採用放射免疫分析法測定血清骨鈣素（BGP）、甲狀徬腺激素（PTH）、血鈣（Ca）、燐（P）。結果肝炎肝硬化患者中骨量減少及骨質疏鬆髮生率為65％（26/40），肝癌組中骨質疏鬆髮生率為70％（14/20），均明顯高于對照組22.5％（9/40），差異有統計學意義（P＜0.05），在Child-Pugh C級患者更顯著（90.9％）。肝硬化、肝癌組的BMD、Ca較對照組降低（1.90±0.33vs2.31±0.11 mmol/L），血清PTH水平明顯高于對照組，有統計學意義P＜0.05。隨著肝功能損害加重，肝硬化、肝癌患者的血Ca逐漸下降，血中PTH水平逐漸升高，BGP水平降低，骨形成減少，原髮性骨質疏鬆不存在這種關繫。肝硬化、肝癌患者的BMD與Ca呈正相關，（r＝0.483，P＜0.05）。結論肝硬化、肝癌患者骨質疏鬆髮病率明顯升高，且髮病率隨肝功能損害的逐漸加重而逐漸升高，其機理可能與血鈣降低、維生素D、Ca、P的代謝紊亂及PTH升高有關。
목적：관찰간경화、간암환자골질소송적발생솔탐토기발병궤제。방법선택병독성간염간경화환자40례、간암환자20례분별작위연구조，선택40례원발성골질소송화골량감소환자작위대조조，채용쌍능X선흡수의（ DXA ）검측골밀도（BMD），병검측골대사상관지표，채용방사면역분석법측정혈청골개소（BGP）、갑상방선격소（PTH）、혈개（Ca）、린（P）。결과간염간경화환자중골량감소급골질소송발생솔위65％（26/40），간암조중골질소송발생솔위70％（14/20），균명현고우대조조22.5％（9/40），차이유통계학의의（P＜0.05），재Child-Pugh C급환자경현저（90.9％）。간경화、간암조적BMD、Ca교대조조강저（1.90±0.33vs2.31±0.11 mmol/L），혈청PTH수평명현고우대조조，유통계학의의P＜0.05。수착간공능손해가중，간경화、간암환자적혈Ca축점하강，혈중PTH수평축점승고，BGP수평강저，골형성감소，원발성골질소송불존재저충관계。간경화、간암환자적BMD여Ca정정상관，（r＝0.483，P＜0.05）。결론간경화、간암환자골질소송발병솔명현승고，차발병솔수간공능손해적축점가중이축점승고，기궤리가능여혈개강저、유생소D、Ca、P적대사문란급PTH승고유관。
Objective To observe the incidence of osteoporosis in patients with liver cirrhosis or liver cancer , and to investigate its pathogenesis .Methods Forty patients with viral hepatitic cirrhosis and 20 patients with liver cancer were selected as study group , respectively.Forty patients with primary osteoporosis and osteopenia were selected as control group .Bone mineral density (BMD) was detected using dual energy X-ray absorptiometry (DXA).Bone metabolism related indicators, including serum osteocalcin (BGP), parathyroid hormone ( PTH) , calcium ( Ca) , and phosphorus ( P) , were detected using radio immunoassay .Results The incidence of bone loss and osteoporosis in patients with hepatitis and cirrhosis was 65% ( 26/40 ) , and the incidence of osteoporosis was 70%(14/20) in the liver cancer group .The incidence in these 2 groups was significantly higher than that in the control group (22.5%, 9/40;P<0.05 ) .And the difference was more prominent in patients with Child-Pugh C liver function ( 90.9%) .BMD and Ca in cirrhosis group and liver cancer group were lower than that in control group (1.90 ±0.33 vs.2.31 ±0.11mmol/L), while serum PTH level was significantly higher than that in control group (P<0.05).Along with the aggravation of the liver function damage , serum Ca in patients with liver cirrhosis or liver cancer declined gradually , while the serum PTH increased gradually .BGP and bone formation also reduced.However, this relationship did not exist in patients with primary osteoporosis .BMD was positively correlated with Ca in patients with liver cirrhosis or liver cancer (r=0.483, P<0.05).Conclusion The incidence of osteoporosis in patients with liver cirrhosis or liver cancer increases significantly .And the incidence increases along with the aggravation of liver function damage .The possible mechanism may be related to the low serum calcium , metabolic disorders in vitamin D, Ca, and P, and elevated PTH.
