慢性阻塞性肺疾病患者骨密度改变的分析

目的 通过测定慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)中、重度患者骨密度(bone mineral density,BMD)、肺功能、血气分析及营养状况的变化,探讨COPD患者BMD的改变与骨质疏松发生的关系.方法 选择43例COPD中、重度患者(缓解期)和40名同龄健康对照人群为研究对象,采用双能X线骨密度检测仪、血气分析仪、肺功能检测仪及生化测定仪等进行BMD、血气分析、肺功能、血浆总蛋白和白蛋白等指标的测定.结果 COPD组第2～4腰椎、股骨颈部、股骨大转子及股骨粗隆间的BMD值较对照组降低(P＜0.05或P＜0.01);COPD组的体质量指数和血浆白蛋白的测定值低于对照组(P＜0.05或P＜0.01);呼吸衰竭患者的股骨颈部和第1～4腰椎的BMD较无呼吸衰竭患者降低(P＜0.05或P＜0.01);COPD组股骨和腰椎的骨质疏松检出率高于对照组(P值均＜0.05).结论 COPD中、重度患者BMD、体质量指数、血浆白蛋白水平均较同龄对照人群降低,呼吸衰竭组较无呼吸衰竭组BMD降低更明显,COPD组股骨和腰椎的骨质疏松检出率高于对照组,表明COPD是一种全身性疾病,其所导致的长期缺氧和营养不良状态与继发性骨质疏松发生有紧密的关系.

Alteration of bone mineral density in patients with chronic obstructive pulmonary disease

Objective To investigate the alteration of bone mineral density(BMD),pulmonary function,blood gas analysis and nutritional state in moderate and severe patients with chronic obstructive pulmonary disease(COPD),and to explore the relationship between chronic obstructive pulmonary disease and osteoporosis.Methods Forty-three patients with COPD and forty controls were studied.Body mass index(BMI),BMD,total protein,albumin,biochemical index relative to the bone formation in blood were measured and analyzed.Results BMD at L2-L4 and left hip which includes fenur neck,fenur GT,InterTro in patients with COPD were significantly lower than those in controls(P＜0.05 or P＜0.01).BMI,album of patients with COPD decreased obviously than those in control(P＜0.05 or P＜0.01).BMD at fenur neck and L2-L4 of patients with respiratory failure was lower than that of non-respiratory failure patients(P＜0.05 or P＜0.01).The incidence of osteoporosis in moderate and severe patients with COPD were much higher than that of the controls(all P＜0.05).Conclusions The reduction of BMI,BMD are more conspicuous than those of the controls.Also there are differences in BMI between respiratory failure patients and non-respiratory failure patients.COPD would be considered as a whole body disease,which can effect the entirety through a great number of sectors.