老年男性慢性阻塞性肺疾病与骨质疏松症相关性研究

目的 探讨老年男性COPD患者骨质疏松症的发生情况及相关影响因素。方法 选择40例老年男性COPD患者为研究对象，30例年龄匹配的男性健康体检者为对照组。应用双能X线吸收测定仪测定腰椎、股骨近端骨密度（BMD）。并测定血清骨钙素、肺功能、动脉血气水平。结果 COPD组腰椎、股骨近端（包括u、12、L3、L4及股骨颈、股骨颈小梁三角、大转子、股骨体）BMD分别为（0．815±0．157）g/cm^2、（0．864±0．165）g/cm^2、（0．958±0．195）g／cm^2、（0．972±0．195）g/cm^2、（0．739±0．110）g／cm^2、（0．542±0．107）g／cm^2、（0．619±0．103）g／cm^2和（0．949±0.153）g／cm^2，均较正常对照组显著降低（P均〈0.01）。COPD组血清骨钙素较正常对照组显著升高（5．67±1．59）ng／mL比（4．37±1．47）ng/mL，P〈0．01]，腰椎、股骨近端骨质疏松发生率较对照组显著升高（65％比40％，50％比20％，P均〈0．05）。COPD组患者BMD在吸烟组较不吸烟组显著降低，使用激素组较未使用激素组显著降低（P〈0．01或P〈0．05）。COPD组腰椎、股骨近端BMD与PaO2、体重指数、FEV，％pred、FEV1／FVC呈显著正相关（P〈0．01或P〈0．05）。结论 老年男性COPD患者BMD低于同年龄健康对照组，骨质疏松发生率增高。COPD继发骨质疏松症为高转换型。缺氧、肺功能指标、低体重指数、吸炯和使用糖皮质激素可能为影响COPD患者BMD的相关因素。

Relationship between osteoporosis and chronic obstructive pulmonary disease in elderly male patients

Objective To evaluate the incidence of osteoporosis and relevant factors in the elderly male patients with chronic obstructive pulmonary disease（COPD）. Methods Forty elderly male patients with COPD and thirty age-matched healthy subjects were enrolled. The bone mineral density （BMD） of lumbar vertebrae and proximal end of the femur were measured by dual energy X-ray absorptiometry. Serum levels of osteocalcin （BGP） and lung function were measured while blood-gas analysis of arterial blood was conducted. Results The BMD of lumbar vertebrae and proximal end of the femur（including lumbar 1 to 4, femoral neck, ward＇s triangle, trochanter and shaft） in the COPD group were significantly lower than those in the control subjects（ all P 〈 0. 01 ）. Serum BGP level in the COPD group was higher than that in the control group （ 5.67 ± 1.59） ng/mL vs （4. 37 ± 1.47 ） ng/mL, P 〈 0. 01 ）. The prevalence of osteoporosis among the COPD patients was significantly higher than that among the control subjects（65% vs 40% ,50% vs 20% , both P 〈 0. 05 ）. BMD in the COPD patients who had a history of smoking was significantly lower than those who did not smoke cigarettes （P 〈 0. 01 or P 〈 0. 05 ）. BMD in the COPD patients treated with glucocorticoid were significantly lower than those who were not receiving glucocorticoid therapy（ P 〈 0. 01 or P 〈 0. 05 ）. BMD was positively correlated with PaO2, BMI, FEV1% pred and FEV1/FVC（ P 〈 0. 01 or P 〈 0. 05 ）. Conclusions Compared with age-matched normal controls,BMD in elderly male COPD patients are significantly lower with increased osteoporosis risk.Osteoporosis induced by COPD is high change-over pattern. BMD in patients with COPD may be correlated with hypoxia,lung function, smoking,low body mass index and glucocorticoids therapy.