老年慢性阻塞性肺疾病患者继发骨质疏松症的影响因素(1)
[摘要] 目的 探讨老年慢性阻塞性肺疾病(COPD)患者继发骨质疏松症(OP)的影响因素。 方法 收集2015年1～8月本科收治的中、重度COPD住院患者50例为COPD组及同期老年健康对照组30例。检测并分析血气、肺功能、骨密度、骨代谢生化指标的变化。 结果 COPD组的左股骨颈、腰椎L1-4 BMD明显低于健康对照组(P<0.05，P<0.01)。与健康对照组比较，COPD组25(OH)D3明显降低(P<0.01)，PTH明显升高(P<0.01)，ALP略升高，Ca2+、P降低(P<0.05)。25(OH)D3水平与FEV1%预计值呈线性正相关(r=0.403，P=0.430)。BMD降低与PaO2水平密切相关(r=0.355，P=0.203)，而与PaCO2和其他生化指标无明显关系。 结论 老年COPD发生OP时，骨吸收大于骨形成。缺氧、25(OH)D3水平降低是COPD继发OP的重要原因。
[关键词] 慢性阻塞性肺疾病；骨质疏松症；血气分析；骨密度
[中图分类号] R563 [文献标识码] A [文章编号] 1674-4721(2016)02(b)-0035-03
Impact factors of secondary osteoporosis in chronic obstructive pulmonary disease patients
WANG Zhi-gang WANG Mei LIN Xue-jun ZHENG Hong-yan
Department of Breath Internal Medicine，People′s Hospital Affiliated to Quanzhou Medical College，Quanzhou 362000，China
[Abstract] Objective To explore the impact factors of secondary osteoporosis (OP) in patients with chronic obstructive pulmonary disease(COPD). Methods 50 patients with medium and serve COPD from January to August 2015 of our hospital and 30 elderly health people were collected.The biochemical index changes of blood gas，pulmonary function，bone density and bone metabolism were detected and analyzed. Results The BMD of left femoral neck and lumbar vertebrae L1-4 in COPD group was obvious lower than that of control group respectively(P<0.05，P<0.01).Compared with control group，the 25(OH)D3 in COPD group decreased obvious(P<0.01)，but the PTH increased obvious(P<0.01)，ALP increased a little and Ca2+，P decreased(P<0.05).The level of 25(OH)D3 had positive relationship with FEV1% predicted value(r=0.403，P=0.430).The decreased BMD had close relationship with PaO2 level(r=0.355，P=0.203)，while had no obvious relationship with other biochemical index. Conclusion When elderly COPD patients with OP，the bone resorption is greater than bone formation.Hypoxia and 25(OH)D3 level decreases are the important reasons for secondary OP in COPD.
[Key words] Chronic obstructive pulmonary disease；Osteoporosis；Blood gas analysis；Bone mineral density
慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是一种可防可治的、具有气流受限不完全可逆且进行性发展特征的疾病。研究表明，其为一种累及全身的慢性炎症疾病，可累及骨骼、心脑血管、血液等多个系统[1]。骨质疏松症(osteoporosis，OP)是COPD重要的系统性合并症之一，在COPD中占36%～60%[2]。以往的研究主要着眼于急性缺氧对骨代谢的影响上，近年来发现慢性持续缺氧对骨骼代谢也起着举足轻重的作用。本实验拟通过测定COPD中、重度患者肺功能，血气分析与骨代谢、骨密度(bone mineral density，BMD)等指标，对老年COPD患者继发OP的影响因素进行初步探讨。
1 资料与方法
1.1 一般资料
选择2015年1～8月本科收治的中、重度COPD住院患者50例为COPD组，年龄65～75岁，平均(67.7±5.8)岁，其中男28例，女22例；吸烟34例，未吸烟16例；病史4～36年，中位数17年，均无死亡或失访。采取分层随机方法，设同期健康对照组30例，年龄60～76岁，平均(62.7±5.3)岁，其中男18例，女12例；吸烟19例，未吸烟11例。两组的性别、年龄和吸烟情况比较，差异无统计学意义(P>0.05)，具有可比性。实验设计经本院医学伦理委员会批准。参与研究对象均签署知情同意书。COPD诊断均符合《中华医学会COPD诊疗指南(2013年修订版)》标准，具体如下：①合并原发性心、肝、肾疾病，原发性高血压病或其他严重躯体疾病者。②合并糖尿病、甲状腺及甲状旁腺等内分泌疾患，服用影响骨代谢药物者。③有明确的继发性OP之病因者。④在诊断COPD前已有骨质疏松表现者。, 百拇医药(王志刚 王梅 林学军 郑红艳)
[关键词] 慢性阻塞性肺疾病；骨质疏松症；血气分析；骨密度
[中图分类号] R563 [文献标识码] A [文章编号] 1674-4721(2016)02(b)-0035-03
Impact factors of secondary osteoporosis in chronic obstructive pulmonary disease patients
WANG Zhi-gang WANG Mei LIN Xue-jun ZHENG Hong-yan
Department of Breath Internal Medicine，People′s Hospital Affiliated to Quanzhou Medical College，Quanzhou 362000，China
[Abstract] Objective To explore the impact factors of secondary osteoporosis (OP) in patients with chronic obstructive pulmonary disease(COPD). Methods 50 patients with medium and serve COPD from January to August 2015 of our hospital and 30 elderly health people were collected.The biochemical index changes of blood gas，pulmonary function，bone density and bone metabolism were detected and analyzed. Results The BMD of left femoral neck and lumbar vertebrae L1-4 in COPD group was obvious lower than that of control group respectively(P<0.05，P<0.01).Compared with control group，the 25(OH)D3 in COPD group decreased obvious(P<0.01)，but the PTH increased obvious(P<0.01)，ALP increased a little and Ca2+，P decreased(P<0.05).The level of 25(OH)D3 had positive relationship with FEV1% predicted value(r=0.403，P=0.430).The decreased BMD had close relationship with PaO2 level(r=0.355，P=0.203)，while had no obvious relationship with other biochemical index. Conclusion When elderly COPD patients with OP，the bone resorption is greater than bone formation.Hypoxia and 25(OH)D3 level decreases are the important reasons for secondary OP in COPD.
[Key words] Chronic obstructive pulmonary disease；Osteoporosis；Blood gas analysis；Bone mineral density
慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是一种可防可治的、具有气流受限不完全可逆且进行性发展特征的疾病。研究表明，其为一种累及全身的慢性炎症疾病，可累及骨骼、心脑血管、血液等多个系统[1]。骨质疏松症(osteoporosis，OP)是COPD重要的系统性合并症之一，在COPD中占36%～60%[2]。以往的研究主要着眼于急性缺氧对骨代谢的影响上，近年来发现慢性持续缺氧对骨骼代谢也起着举足轻重的作用。本实验拟通过测定COPD中、重度患者肺功能，血气分析与骨代谢、骨密度(bone mineral density，BMD)等指标，对老年COPD患者继发OP的影响因素进行初步探讨。
1 资料与方法
1.1 一般资料
选择2015年1～8月本科收治的中、重度COPD住院患者50例为COPD组，年龄65～75岁，平均(67.7±5.8)岁，其中男28例，女22例；吸烟34例，未吸烟16例；病史4～36年，中位数17年，均无死亡或失访。采取分层随机方法，设同期健康对照组30例，年龄60～76岁，平均(62.7±5.3)岁，其中男18例，女12例；吸烟19例，未吸烟11例。两组的性别、年龄和吸烟情况比较，差异无统计学意义(P>0.05)，具有可比性。实验设计经本院医学伦理委员会批准。参与研究对象均签署知情同意书。COPD诊断均符合《中华医学会COPD诊疗指南(2013年修订版)》标准，具体如下：①合并原发性心、肝、肾疾病，原发性高血压病或其他严重躯体疾病者。②合并糖尿病、甲状腺及甲状旁腺等内分泌疾患，服用影响骨代谢药物者。③有明确的继发性OP之病因者。④在诊断COPD前已有骨质疏松表现者。, 百拇医药(王志刚 王梅 林学军 郑红艳)