慢性阻塞性肺疾病患者骨密度改变及相关因素分析
만성조새성폐질병환자골밀도개변급상관인소분석
Changes of bone mineral density of patients with chronic obstructive pulmonary disease and analysis of the related factors
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2013年 7期 9-14 ,共6页

    秦潇%冷松%王镇山

    진소%랭송%왕진산

    肺疾病,慢性阻塞性%骨质疏松%呼吸功能试验%血气分析 肺疾病,慢性阻塞性%骨質疏鬆%呼吸功能試驗%血氣分析
    폐질병,만성조새성%골질소송%호흡공능시험%혈기분석
    Lung diseases,obstructive%Osteoporosis%Respiratory function tests%Blood gas analysis
    目的 通过测定慢性阻塞性肺疾病(COPD)患者骨密度、肺功能、血气分析、血清钙离子、超敏C反应蛋白(hs-CRP)及生活质量的变化,探讨COPD对骨密度的影响.方法 采用超声波干式骨密度仪测定32例COPD患者(COPD组)和35例健康体检者(对照组)的骨密度,测量部位为左侧跟骨,骨密度指标包括超声波传递速度(SOS)、SOS T、骨折风险系数(OSI)、骨强度(TI).COPD组根据肺功能分为轻度3例、中度14例和重度15例；根据骨密度分为骨密度正常3例、骨密度减少24例和骨质疏松5例；根据既往有无全身性糖皮质激素应用史,分为既往有全身性糖皮质激素应用史10例和既往无全身性糖皮质激素应用史22例.比较COPD组与对照组的骨密度水平,分析COPD患者的骨密度与肺功能、血气分析、血清钙离子、hs-CRP及生活质量的相关性.结果 COPD组与对照组比较,骨密度减低(P＜0.05).重度COPD患者较中度COPD患者骨密度减低(P＜0.05),重度COPD患者较轻度COPD患者SOS减低(P＜0.05),SOS、SOS T、TI比较差异无统计学意义(P＞0.05),中度COPD患者与轻度COPD患者比较差异无统计学意义(P＞0.05)；骨质疏松COPD患者较骨密度减少COPD患者及骨密度正常COPD患者的动脉血氧分压(PaO2)明显降低,hs-CRP及COPD评估测试(CAT)评分明显升高；骨密度减少COPD患者较骨密度正常COPD患者的PaO2降低,CAT评分升高(P＜0.05)；骨密度正常、骨密度减少及骨质疏松COPD患者之间血清钙离子浓度比较差异无统计学意义(P＞0.05)；既往有全身性糖皮质激素应用史COPD患者较既往无全身性糖皮质激素应用史COPD患者骨密度减低(P＜0.05).相关性分析表明SOS、SOST、OSI、TI均与第1秒用力呼气容积占预计值的百分比(FEV1％)有相关性(r值分别为0.389、0.262、-0.295、0.265,P值均＜0.05),与PaO2有相关性(r值分别为0.391、0.100、-0.374、0.122,P值均＜0.05),与CAT评分也有相关性(r值分别为-0.659、-0.463、0.175、-0.178,P值均＜0.05),SOS与hs-CRP呈负相关(r=-0.390,P＜0.05)；Logistic回归分析表明PaO2和FEV1％是COPD患者骨密度减低的危险因素.结论 COPD患者的骨密度较同龄健康体检者减低,PaO2减低、肺功能差是骨密度减低的危险因素,推测与COPD的慢性炎性反应有关.
    목적 통과측정만성조새성폐질병(COPD)환자골밀도、폐공능、혈기분석、혈청개리자、초민C반응단백(hs-CRP)급생활질량적변화,탐토COPD대골밀도적영향.방법 채용초성파간식골밀도의측정32례COPD환자(COPD조)화35례건강체검자(대조조)적골밀도,측량부위위좌측근골,골밀도지표포괄초성파전체속도(SOS)、SOS T、골절풍험계수(OSI)、골강도(TI).COPD조근거폐공능분위경도3례、중도14례화중도15례；근거골밀도분위골밀도정상3례、골밀도감소24례화골질소송5례；근거기왕유무전신성당피질격소응용사,분위기왕유전신성당피질격소응용사10례화기왕무전신성당피질격소응용사22례.비교COPD조여대조조적골밀도수평,분석COPD환자적골밀도여폐공능、혈기분석、혈청개리자、hs-CRP급생활질량적상관성.결과 COPD조여대조조비교,골밀도감저(P＜0.05).중도COPD환자교중도COPD환자골밀도감저(P＜0.05),중도COPD환자교경도COPD환자SOS감저(P＜0.05),SOS、SOS T、TI비교차이무통계학의의(P＞0.05),중도COPD환자여경도COPD환자비교차이무통계학의의(P＞0.05)；골질소송COPD환자교골밀도감소COPD환자급골밀도정상COPD환자적동맥혈양분압(PaO2)명현강저,hs-CRP급COPD평고측시(CAT)평분명현승고；골밀도감소COPD환자교골밀도정상COPD환자적PaO2강저,CAT평분승고(P＜0.05)；골밀도정상、골밀도감소급골질소송COPD환자지간혈청개리자농도비교차이무통계학의의(P＞0.05)；기왕유전신성당피질격소응용사COPD환자교기왕무전신성당피질격소응용사COPD환자골밀도감저(P＜0.05).상관성분석표명SOS、SOST、OSI、TI균여제1초용력호기용적점예계치적백분비(FEV1％)유상관성(r치분별위0.389、0.262、-0.295、0.265,P치균＜0.05),여PaO2유상관성(r치분별위0.391、0.100、-0.374、0.122,P치균＜0.05),여CAT평분야유상관성(r치분별위-0.659、-0.463、0.175、-0.178,P치균＜0.05),SOS여hs-CRP정부상관(r=-0.390,P＜0.05)；Logistic회귀분석표명PaO2화FEV1％시COPD환자골밀도감저적위험인소.결론 COPD환자적골밀도교동령건강체검자감저,PaO2감저、폐공능차시골밀도감저적위험인소,추측여COPD적만성염성반응유관.
    Objective To study the relationship between chronic obstructive pulmonary disease (COPD) and osteoporosis by measuring the bone mineral density (BMD),lung function,blood gas analysis,calcium ion,high sensitive C reactive protein (hs-CRP) and the quality of life.Methods BMD measuring was performed by ultrasound dry bone densitometer in 32 patients with COPD (COPD group) and 35 healthy controls (control group).The ultrasonic transmission speed (SOS),SOS T,fracture risk factor (OSI) and bone strength (TI) were measured at the sites of the left calcaneus.COPD group was divided into three groups according to lung function,3 cases of mild,14 cases of moderate and 15 cases of severe.According to the level of BMD,there were another three groups,3 cases with normal BMD,24 cases with lower BMD,and 5 cases with osteoporosis.According to the history of systemic glucocorticoid application,COPD group was divided into two groups,10 cases with glucocorticoid application and 22 cases without glucocorticoid application.The levels of BMD between COPD group and control group were compared,and the correlation between BMD and lung function,blood gas analysis,calcium ion,hs-CRP and the quality of life in patients with COPD was analyzed.Results COPD group had lower BMD than that in control group (P ＜ 0.05).In COPD group,the severe patients had lower BMD than the moderate patients (P ＜ 0.05),and the severe patients had only lower SOS than the mild patients(P ＜ 0.05),but there was no statistic significant difference in BMD between the moderate and mild patients(P ＞ 0.05).According to the level of BMD,the osteoporosis patients had lower arterial oxygen tension (PaO2) and higher hs-CRP and COPD assessment test (CAT) than the normal BMD and lower BMD patients,and the lower BMD patients had lower PaO2 and higher CAT than the normal BMD patients (P ＜ 0.05),but there was no statistic significant difference in calcium ion among them(P ＞ 0.05).According to the history of systemic glucocorticoid application,the patients with glucocorticoid application had lower level of BMD than the other patients (P ＜ 0.05).SOS,SOS T,OSI and TI was correlated with one second forced expiratory volume percent predicted (FEV1％) (r =0.389,0.262,-0.295,0.265; P＜0.05),also correlated with PaO2 (r =0.391,0.100,-0.374,0.122;P＜0.05),and also correlated with CAT (r =-0.659,-0.463,0.175,-0.178 ; P ＜ 0.05).There was only a negative correlation between SOS and hs-CRP (r =-0.390,P ＜ 0.05).Further in Logistic regression analysis,the results showed that both PaO2 and FEV1％ were the risk factors of BMD reduction.Conclusions Patients with COPD have lower BMD than their peers of healthy.The reduction of blood oxygen pressure and lung function are the risk factors of BMD reduction.There is a conjecture that the reduced BMD is correlated with chronic inflammation in patients with COPD.
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