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| 库欣综合征合并骨质疏松症患者的临床特点及骨密度相关因素分析 |
| Clinical characteristics and factors associated with bone mineral density in patients with Cushing's syndrome combined with osteoporosis |
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| DOI：10.3969/j.issn.1006-7108.2018.08.011 |
| 中文关键词: 库欣综合征 骨质疏松 骨密度 |
| 英文关键词:Cushing's Syndrome Osteoporosis Bone Mineral Density |
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| 中文摘要: |
| 目的 分析库欣综合征合并骨质疏松症患者的临床特点，并探讨影响骨密度（bone mineral density, BMD）的相关因素。方法 回顾分析70例库欣综合征患者的临床资料，根据BMD分为正常骨量（n=10）、骨量减少（n=32）和骨质疏松（n=28）共三组，进行临床特点比较，并分析影响BMD的相关因素；根据是否合并脆性骨折比较骨折组与非骨折组的临床特点。结果 ① 70例患者年龄15~75岁（平均44.7岁）,男女比例为1:2.89，病程2个月~30年（平均4.83年）,骨质疏松比例40.0%，脆性骨折比例25.7%，骨折部位腰椎最常见（50.0%）。②25-OHD水平正常骨量组高于骨质疏松组（P=0.015）及骨量减少组（P=0.014）；骨钙素（osteocalcin，OC）正常骨量组高于骨量减少组（P<0.001）及骨质疏松组（P<0.001）。③25-OHD水平非骨折组高于骨折组（P=0.001）；校正性别、年龄、病程后，腰椎、股骨颈和全髋BMD骨折组均低于非骨折组（P值分别为0.009、0.006和0.002）。④血皮质醇是影响腰椎骨密度独立危险因素（t值=-2.379, P= 0.020）。结论 库欣综合征导致继发性骨质疏松发生率高，其造成脆性骨折发生率高，腰椎部位骨折最常见；库欣综合征合并骨质疏松患者25-OHD和OC水平更低,骨形成明显受抑；骨折组与非骨折组相比，25-OHD水平更低,骨密度更低；血皮质醇是影响腰椎骨密度的独立危险因素。 |
| 英文摘要: |
| Objective The objective was to analyze the clinical characteristics of patients with Cushing's syndrome combined with osteoporosis, and to explore factors associated with bone mineral density (BMD). Methods 70 cases of Cushing's syndrome were analyzed and grouped into normal bone density group (n=10), osteopenia group (n=32) and osteoporosis group (n=28). Results ① The average age was 44.67 years, and the ratio of male to female was 1:2.89. The ratio of osteoporosis was 40%. The proportion of patients had fracture was 25.7% and lumbar spine fracture accounted for 50% of all fractures. ② The level of 25-OHD in the normal bone density group was higher than that in osteoporosis group and osteopenia group (P=0.015 and P=0.014, respectively). The level of osteocalcin (OC) in the normal bone density group was higher than that in osteoporosis group and osteopenia group (P< 0.001). ③ The level of 25-OHD in the non-fracture group was higher than that in the fracture group (P=0.001). When gender, age and disease duration were accounted for, BMD of femoral neck, hip and lumbar spine in the fracture group were all lower than that in the non-fracture group (P values were 0.006, 0.002 and 0.009, respectively). ④ Stepwise regression analysis showed that serum cortisol was an independent risk factor for lumbar spine BMD (t=-2.379, P= 0.020). Conclusions Cushing's syndrome led to a high incidence of secondary osteoporosis, which resulted in a high incidence of brittle fracture and mostly located at lumbar spine. The levels of 25-OHD and OC were lower in patients with osteoporosis and Cushing's syndrome and bone formation was significantly inhibited. The fracture group had lower 25-OHD levels and lower BMD than the non-fracture group. Blood cortisol is an independent risk factor for lumbar spine BMD. |
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