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| 肝硬化、肝癌患者骨代谢生化指标与骨质疏松的临床研究 |
| Clinical study of bone metabolic and biochemical indexes and osteoporosis in patients with liver cirrhosis or liver cancer |
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| DOI：10.3969/j.issn.1006.7108.2013.11.015 |
| 中文关键词: 肝硬化 肝癌 骨质疏松 骨密度 骨钙素 |
| 英文关键词:Cirrhosis Liver cancer Osteoporosis Bone mineral density Osteocalcin |
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| 中文摘要: |
| 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。 |
| 英文摘要: |
| 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 hepatitis 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-Hugh 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. 11 mmol/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 he related to the low serum calcium，metabolic disorders in vitamin D，Ca, and P，and elevated PTH . |
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