目的 探討老年男性COPD患者骨質(zhì)疏松癥的發(fā)生情況及相關(guān)影響因素。方法 選擇40例老年男性COPD患者為研究對(duì)象,30例年齡匹配的男性健康體檢者為對(duì)照組。應(yīng)用雙能X線吸收測(cè)定儀測(cè)定腰椎、股骨近端骨密度(BMD)。并測(cè)定血清骨鈣素、肺功能、動(dòng)脈血?dú)馑健?b>結(jié)果 COPD組腰椎、股骨近端(包括L1、L2、L3、L4及股骨頸、股骨頸小梁三角、大轉(zhuǎn)子、股骨體)BMD分別為(0.815±0.157)g/cm2、(0.864±0.165)g/cm2、(0.958±0.195)g/cm2、(0.972±0.195)g/cm2﹑(0.739±0.110)g/cm2、(0.542±0.107)g/cm2、(0.619±0.103)g/cm2和(0.949±0.153)g/cm2,均較正常對(duì)照組顯著降低(P均 lt;0.01)。COPD組血清骨鈣素較正常對(duì)照組顯著升高[(5.67±1.59)ng/mL比(4.37±1.47)ng/mL,P lt;0.01),腰椎、股骨近端骨質(zhì)疏松發(fā)生率較對(duì)照組顯著升高(65%比40%,50%比20%,P均 lt;0.05)。COPD組患者BMD在吸煙組較不吸煙組顯著降低,使用激素組較未使用激素組顯著降低(P lt;0.01或P lt;0.05)。COPD組腰椎、股骨近端BMD與PaO2、體重指數(shù)、FEV1%pred、FEV1/FVC呈顯著正相關(guān)(P lt;0.01或P lt;0.05)。結(jié)論 老年男性COPD患者BMD低于同年齡健康對(duì)照組,骨質(zhì)疏松發(fā)生率增高。COPD繼發(fā)骨質(zhì)疏松癥為高轉(zhuǎn)換型。缺氧、肺功能指標(biāo)、低體重指數(shù)、吸煙和使用糖皮質(zhì)激素可能為影響COPD患者BMD的相關(guān)因素。
引用本文: 陳紅,李為民. 老年男性慢性阻塞性肺疾病與骨質(zhì)疏松癥相關(guān)性研究. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 08(4): 263-267. doi: 復(fù)制
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2. | Jørgensen NR,Schwarz P,Holme I,et al.The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease:a cross sectional study.Respir Med,2007,101:177-185. |
3. | 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì)慢性阻塞性肺疾病學(xué)組.慢性阻塞性肺疾病診治指南.中華內(nèi)科雜志,2002,41:640-646. |
4. | Bolton CE,Ionescu AA,Shiels KM,et al.Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2004,170:1286-1293. |
5. | Balasubramanian VP,Varkey B.Chronic obstructive pulmonary disease:effects beyond the lungs.Curr Opin Pulm Med,2006,12:106-112. |
6. | Papaioannou A,Parkinson W,F(xiàn)erko N,et al.Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada.Osteoporos Int,2003,14:913-917. |
7. | 李斯南.43例慢性阻塞性肺病患者骨密度和骨代謝的改變.醫(yī)藥論壇雜志,2003,24:27-28. |
8. | 郭素華,楊定焯,許志奇,等.從慢性支氣管炎的骨密度改變論久咳傷腎.華西醫(yī)學(xué), 1992, 7:46-47. |
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10. | Kumeda Y,Lnaba M,Nishizawa Y.Secondary osteporosis and its treatment--diabetes mellitus.Nippon Rinsho,1998,56:1579-1586. |
11. | Sin DD,Man JP,Man SF.The risk of osteoporosis in Caucasian men and women with obstructive airways disease.Am J Med,2003,114:10-14. |
12. | Wouters EF,Creutzberg EC,Schols AM.Systemic effects in COPD.Chest,2002,121:127S-130S. |
13. | Varkey AB.Chronic obstructive pulmonary disease in women:exploring gender differences.Curr Opin in Pulm Med,2004,10:98-103. |
14. | Katsura H,Kida K.A comparison of bone mineral density in elderly female patients with COPD and bronchial asthma.Chest,2002,122:1949-1955. |
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16. | Gan WQ,Man SF,Senthilselvan A,et al.Association between chronic obstructive pulmonary disease and systemic inflammation:a systematic review and a meta-analysis.Thorax,2004,59:574-580. |
17. | Eid AA,Ionescu AA,Nixon LS,et al.Inflammatory response and body composition in chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2001,164:1414-1418. |
18. | 李衛(wèi),苗懿德.老年男性慢性阻塞性肺疾病患者骨代謝的研究.中國(guó)骨質(zhì)疏松雜志,2005,11:221-224. |
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28. | Lane NE,Lukert B.The science and therapy of glucocorticoid-induced bone loss.Endocrinol Metab Clin North Am,1998,27:465-483. |
- 1. Spurzem JR,Rennard SI.Pathogenesis of COPD.Semin Respir Crit Care Med,2005,26:142-153.
- 2. Jørgensen NR,Schwarz P,Holme I,et al.The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease:a cross sectional study.Respir Med,2007,101:177-185.
- 3. 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì)慢性阻塞性肺疾病學(xué)組.慢性阻塞性肺疾病診治指南.中華內(nèi)科雜志,2002,41:640-646.
- 4. Bolton CE,Ionescu AA,Shiels KM,et al.Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2004,170:1286-1293.
- 5. Balasubramanian VP,Varkey B.Chronic obstructive pulmonary disease:effects beyond the lungs.Curr Opin Pulm Med,2006,12:106-112.
- 6. Papaioannou A,Parkinson W,F(xiàn)erko N,et al.Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada.Osteoporos Int,2003,14:913-917.
- 7. 李斯南.43例慢性阻塞性肺病患者骨密度和骨代謝的改變.醫(yī)藥論壇雜志,2003,24:27-28.
- 8. 郭素華,楊定焯,許志奇,等.從慢性支氣管炎的骨密度改變論久咳傷腎.華西醫(yī)學(xué), 1992, 7:46-47.
- 9. 辛洪濤,侯林江,孔祥輝. 慢性阻塞性肺病鈣磷調(diào)節(jié)激素與骨礦含量的研究.實(shí)用中西醫(yī)結(jié)合雜志,1998,11:577-579.
- 10. Kumeda Y,Lnaba M,Nishizawa Y.Secondary osteporosis and its treatment--diabetes mellitus.Nippon Rinsho,1998,56:1579-1586.
- 11. Sin DD,Man JP,Man SF.The risk of osteoporosis in Caucasian men and women with obstructive airways disease.Am J Med,2003,114:10-14.
- 12. Wouters EF,Creutzberg EC,Schols AM.Systemic effects in COPD.Chest,2002,121:127S-130S.
- 13. Varkey AB.Chronic obstructive pulmonary disease in women:exploring gender differences.Curr Opin in Pulm Med,2004,10:98-103.
- 14. Katsura H,Kida K.A comparison of bone mineral density in elderly female patients with COPD and bronchial asthma.Chest,2002,122:1949-1955.
- 15. Tschopp O,Boehler A,Speich R,et al.Osteoporosis before lung transplantation:association with low body mass index,but not with underlying disease.Am J Transplant,2002,2:167-172.
- 16. Gan WQ,Man SF,Senthilselvan A,et al.Association between chronic obstructive pulmonary disease and systemic inflammation:a systematic review and a meta-analysis.Thorax,2004,59:574-580.
- 17. Eid AA,Ionescu AA,Nixon LS,et al.Inflammatory response and body composition in chronic obstructive pulmonary disease.Am J Respir Crit Care Med,2001,164:1414-1418.
- 18. 李衛(wèi),苗懿德.老年男性慢性阻塞性肺疾病患者骨代謝的研究.中國(guó)骨質(zhì)疏松雜志,2005,11:221-224.
- 19. 凌萬軍,葛春方.煙酒對(duì)骨密度的影響.中華預(yù)防醫(yī)學(xué)雜志,1999,33:63.
- 20. Shane E,Silverberg SJ,Donovan D,et al.Osteoporosis in lung transplantation candidates with end-stage pulmonary disease.Am J Med,1996,101:262-269.
- 21. Seeman E.The effects of tobacoo and alconol use on bone.In:Marcus R,F(xiàn)eldman D,Kelsey J,eds.Osteoporosis.Osteoporosis.San Diego:Academic Press,1996,577-597.
- 22. Gan WQ,Man SF,Sin DD.Effects of inhaled corticosteroids on sputum cell counts in stable chronic obstructive pulmonary disease:a systematic review and a meta-analysis.BMC Pulm Med,2005,5:3.
- 23. Sin DD,Wu L,Anderson JA,et al.Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease.Thorax,2005,60:992-997.
- 24. Lung Health Study Research Group.Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease.N Engl J Med,2000,343:1902-1909.
- 25. Scanlon PD,Connett JE,Wise RA,et al.Loss of bone density with inhaled triamcinolone in Lung Health Study II.Am J Respir Crit Care Med,2004;170:1302-1309.
- 26. Canalis E.Clinical review 83:Mechanisms of glucocorticoid action in bone:implications to glucocorticoid-induced osteoporosis.J Clin Endocrinol Metab,1996,81:3441-3447.
- 27. Adachi JD.Corticosteroid-induced osteoporosis.Am J Med Sci,1997,313:41-49.
- 28. Lane NE,Lukert B.The science and therapy of glucocorticoid-induced bone loss.Endocrinol Metab Clin North Am,1998,27:465-483.