中老年男性非酒精性脂肪肝患者不同部位骨密度的变化及相关性研究

目的探讨中老年男性非酒精性脂肪肝(NAFLD)患者不同年龄、不同部位的骨密度(BMD)变化及其相关因素。方法将475例男性NAFLD患者根据年龄分为3组:50-59岁、60~69岁、70岁以上组,收集所有患者的临床资料、不同部位BMD和不同部位骨质疏松发生率并进行比较。采用Peaso“相关分析评估患者各部位骨质疏松相关因素,采用线性回归分析探讨患者各部位BMD降低的危险因素。结果中老年男性NAFLD患者随着年龄增长,BMD逐渐下降,骨质疏松发生率逐渐升高;50~59岁组患者腰椎BMD高于股骨颈及桡骨远端1/3,且桡骨远端1/3骨质疏松的发生率明显高于腰椎及股骨颈,差异有统计学意义(P<0.05)。60~69岁组患者腰椎及股骨颈BMD明显高于桡骨远端1/3,差异有统计学意义(P<0.05),而腰椎和股骨颈BMD比较差异无统计学意义(P>0.05).70岁以上组患者不同部位BMD及骨质疏松发生率比较差异无统计学意义(P>0.05)。年龄、25-羟基维生素D25-(OH)D]水平降低是腰椎、股骨颈、挠骨远端1/3 BMD降低的共同危险因素,而BMI、血钙降低是腰椎BMD降低的保护因素,但两者对股骨颈及桡骨BMD降低无明显保护作用。空腹血糖、血磷升高是橈骨远端1/3BMD降低的危险因素。结论中老年男性NAFLD患者随着年龄增大,BMD逐渐下降,完善桡骨BMD测定可降低骨质疏松的漏诊率。BMI升高对腰椎骨密度具有保护作用,但对股骨颈及桡骨无明显作用。

Change and correlation of bone mineral density in different parts of medium-elderly men with nonalcoholic fatty liver disease

Objective To investigate the change and correlation of bone mineral density(BMD)in different age and different parts of medium-elderly men with nonalcoholic fatty liver disease.Methods A total 475 male patients with NAFLD were divided into 3 groups according the age:50-59 year-old、60~69 year-old and above 70 year-old group.Clinical data,BMD and the incidence rate of osteoporosis in different parts between 3 groups were compared.Pearson correlation analysis were used to evaluate the related factors of osteoporosis in different sites and linear regression analysis were used to explore the risk factors of BMD in different parts.Results As the patients grew older,BMD decreased and the incidence of osteoporosis increased.In 50-59 year-old group,BMD in lumbar was higher than that in 1/3 of the distal radius and femoral neck and the incidence of osteoporosis in 1/3 of the distal radius was higher than that in femoral and lumbar(P>0.05).In 60-69 year-old group,BMD in femoral neck and lumbar was higher than that in 1/3 of the distal radius(P<0.05).There were no statistical difference in BMD between 1/3 of the distal radius,femoral neck and lumbar in above 70 year-old group.Age and 25(OH)D deficiency were common risk factors for BMD loss in lumbar,femoral neck and 1/3 of the distal radius.However,BMI and blood calcium had protective effects on bone mineral density in lumbar,but had no protective effects in femoral neck and radius.Fasting plasma glucose(FPG)and blood phosphor were risk factors for BMD loss in radius.Conclusion As the patients grow older,the BMD decreased and the incidence of osteoporosis increased.The BMD in radius should be examined to reduce the missed diagnosis of osteoporosis.BMI had protective effect on BMD in lumbar but no effect in radius and femoral neck.