扩张性心肌病患者骨代谢指标状况及其临床意义

目的探究扩张性心肌病(dilated cardiomyopathy,DCM)患者骨代谢指标水平状况及其临床意义。方法选取2016年3月至2018年3月在我院诊治的DCM患者48例作为研究对象并归入DCM组,选择同期在我院接受健康体检的成年人30名归入健康组,测定和比较两组的血清骨钙素(BGP)、钙(ICa)、骨特异性碱性磷酸酶(BALP)、甲状旁腺激素(PTH)、25羟基维生素D_3[25(OH) D_3]等骨代谢指标水平,以及大粗隆、股骨颈、腰椎等部位的骨密度(BMD),分析骨代谢指标BGP、ICa、BALP、PTH和25(OH) D_3分别与患者年龄、DCM病程、BMI、肌酸激酶同工酶、肌钙蛋白I和心功能分级等因素的相关性。结果(1) DCM组的BGP、ICa、25(OH) D_3等水平均低于健康组,BALP、PTH水平均高于健康组,差异均有统计学意义(P均0.05)。(2) DCM组大粗隆部位的BMD与健康组比较,差异无统计学意义(P0.05); DCM组的股骨颈及腰椎部位的BMD均低于健康组,差异均有统计学意义(P均0.05)。(3) BGP、ICa和25(OH) D_3分别与年龄、DCM病程及心功能分级呈负相关,BGP与肌酸激酶同工酶、肌钙蛋白Ⅰ呈负相关; BALP与年龄、DCM病程、肌酸激酶同工酶、肌钙蛋白Ⅰ及心功能分级呈正相关,PTH与心功能分级呈正相关(P均0.05)。结论 DCM患者的血清BGP、ICa、BALP、PTH、25(OH) D_3等骨代谢相关指标水平有明显波动,且骨代谢相关指标水平与DCM患者年龄、病程、肌酸激酶同工酶、肌钙蛋白Ⅰ及心功能分级等相关,DCM可能是造成骨代谢指标水平发生异常的重要原因。

The status of bone metabolism in patients with dilated cardiomyopathy and its clinical significance

Objective To explore the level of bone metabolism and its clinical significance in patients with dilated cardiomyopathy (DCM). Methods Forty-eight patients with DCM who were treated in our hospital from March 2018 to March 2020 were selected as study subjects and classified into the DCM group. Thirty healthy adults who received physical examination in our hospital during the same period were selected and classified into the healthy group. Serum levels of BGP, ICa, BALP, PTH, 25(OH)D3, and other bone metabolic indicators were measured and compared between the two groups. Bone mineral density (BMD) of the greater trochanter, femoral neck, and lumbar spine was determined. The correlation of BGP, ICa, BALP, PTH and 25 (OH) D3 of bone metabolism indexes with patient age, DCM disease course, BMI, creatine kinase isoenzyme, troponin I and cardiac function grading was analyzed, respectively. Results (1) BGP, ICa, 25(OH)D3 and other levels in the DCM group were all lower than those in the healthy group, and BALP and PTH levels were higher than those in the healthy group, with statistically significant differences (all P < 0.05). (2) There was no significant difference in BMD between DCM group and healthy group (P>0.05). The BMD of the femoral neck and lumbar spine in the DCM group was lower than that in the healthy group, and the difference was statistically significant (All P < 0.05). (3) BGP, ICa, and 25 (OH) D3 were negatively correlated with age, DCM course, and grade of cardiac function, respectively. BGP was negatively correlated with creatine kinase isoenzyme and troponin I. BALP was positively correlated with age, DCM course, creatine kinase isoenzyme, troponin I, and cardiac function grade. PTH was positively correlated with cardiac function grade (all P < 0.05). Conclusion There was significant fluctuation in serum BGP, ICa, BALP, PTH, 25 (OH) D3 and other bone metabolic indicators in patients with DCM. Bone metabolism related indexes were related to the age, course of disease, cardiac function grade, cardiac troponin I, and creatine kinase isoenzyme in DCM patients. DCM may be an important reason for the disorder of bone metabolic indicators.