本文選題：肝硬化 + 骨質(zhì)疏松癥��； 參考：《吉林大學》2017年碩士論文

【摘要】：背景和目的:骨質(zhì)疏松癥(osteoporosis,OP)是肝硬化患者的骨骼并發(fā)癥,常無明顯癥狀,如果不及時治療,會增加骨折風險和影響患者的生活質(zhì)量。近年來,國外研究表明,肝硬化是OP的危險因素,但肝硬化患者OP發(fā)生率報道各不相同,我國肝硬化患者較多,但目前國內(nèi)關(guān)于肝硬化合并OP的發(fā)生率研究缺乏大樣本數(shù)據(jù)。本研究旨在通過檢測肝硬化患者骨密度(BMD)及25-羥維生素D[25(OH)D]水平,回顧性分析肝硬化患者合并OP的相關(guān)情況。方法:本研究終納入2014年12月-2016年12月在吉林大學第一醫(yī)院肝病科住院的肝硬化患者280例為研究對象,其中男性168例(60%),女性112例(40%),年齡在34-71歲,平均年齡在55.48±9.06歲。所有患者均采用雙能X線吸收法檢測腰椎(腰1-4)和股骨頸BMD水平,應用液相色譜-串聯(lián)質(zhì)譜法檢測血清25(OH)D濃度。選擇本院同期年齡、性別相匹配的非肝病住院患者280例為對照組。按照病因?qū)⒀芯繉ο蠓譃樵l(fā)性膽汁性肝硬化,即PBC組(40例)和非原發(fā)性膽汁性肝硬化組,即非PBC組(240例),其中非PBC組包括:乙肝肝硬化組(HBV組,110例),丙肝肝硬化組(HCV組,80例)、和酒精肝肝硬化組(ALD組,50例)。根據(jù)肝硬化嚴重程度,按照肝功能Child-Pugh分級A、B、C級將研究對象分為對應的A組、B組、C組。分析比較各組間BMD,25(OH)D水平及OP發(fā)生情況。結(jié)果:1、280例肝硬化患者中,共有61例發(fā)生OP,OP發(fā)生率21.79%(61/280);正常對照組280例,共有29例發(fā)生OP,OP發(fā)生率10.36%(29/280),肝硬化組的OP發(fā)生率明顯高于對照組。肝硬化組腰椎BMD:L1-4,0.757±0.154(g/cm~2),股骨頸0.650±0.147(g/cm~2),分別明顯低于正常對照組的0.988±0.145(g/cm~2),0.843±0.153(g/cm~2);肝硬化組25(OH)D水平17.89±12.88 ng/ml,明顯低于對照組的28.01±11.89(ng/ml)(p0.001);肝硬化組與對照組BMD及25(OH)D水平均具有統(tǒng)計學差異。2、肝硬化組以Child-Pugh分級分組,將患者分為A、B、C三組。A組、B組、C組腰椎(L1-4)BMD分別為:0.843±0.169(g/cm~2),0.684±0.153(g/cm~2),0.597±0.161(g/cm~2);股骨頸BMD分別為:0.721±0.178(g/cm~2),0.587±0.166(g/cm~2),0.501±0.158(g/cm~2)。從A級到C級,患者BMD呈現(xiàn)下降趨勢,且C級BMD水平明顯低于A級。A組、B組、C組25(OH)D分別為20.89±11.79(ng/ml),19.24±11.93(ng/ml),12.49±9.21(ng/ml)。從A級到C級,25(OH)D逐漸下降,且C級25(OH)D水平明顯低于A級。A-C組分別有11,29,21例發(fā)生OP,OP發(fā)生率分別為:14.10%,22.31%,29.17%,從A級到C級,OP發(fā)生率逐漸上升,C級OP發(fā)生率明顯高于A級。3、40例PBC患者中,男性4例,女性36例,平均年齡:56.11±11.38歲。17例發(fā)生OP,OP發(fā)生率為:42.50%(17/40);240例非PBC組中,44例發(fā)生OP,OP發(fā)生率為18.33%(44/240),PBC組OP發(fā)生率顯著高于非PBC組(p=0.001)。PBC組BMD:腰椎L1-4,0.505±0.148(g/cm~2),股骨頸0.424±0.132(g/cm~2),分別明顯低于非PBC組的BMD:腰椎L1-4為0.799±0.149(g/cm~2)和股骨頸0.688±0.133(g/cm~2)。PBC組25(OH)D濃度為18.99±11.34(ng/ml),低于非PBC組的22.79±12.98(ng/ml),但兩者無統(tǒng)計學差異。4、PBC組、HBV組、HCV組、AMD組腰椎(L1-4)BMD分別為:0.505±0.148(g/cm~2)、0.758±0.143(g/cm~2)、0.713±0.151(g/cm~2)、0.653±0.146(g/cm~2);股骨頸BMD分別為:0.424±0.132(g/cm~2)、0.724±0.136(g/cm~2)、0.690±0.157(g/cm~2)、0.613±0.168(g/cm~2),各組年齡差異均無統(tǒng)計學意義。經(jīng)方差分析及兩兩比較,PBC組腰椎(L1-4)和股骨頸BMD均分別低于HBV組、HCV組和ALD組;而非PBC組內(nèi)各組之間BMD均無明顯差異(p0.05)。40例PBC患者中,17例發(fā)生OP,OP發(fā)生率為:42.50%(17/40);110例HBV肝硬化患者中,18例發(fā)生OP,發(fā)生率為16.36%(18/110);80例HCV肝硬化患者中,13例發(fā)生OP,OP發(fā)生率為16.25%(13/80);50例ALD患者中,13例發(fā)生OP,發(fā)生率為26.00%(13/50)。HBV組、HCV組、ALD組組間OP發(fā)生率無明顯統(tǒng)計學差異;PBC組OP發(fā)生率高于其他肝硬化組,并且顯著高于HBV組(p=0.001)、HCV組(p=0.002),與ALD組間無統(tǒng)計學差異(p=0.099)。結(jié)論:肝硬化患者的25(OH)D及骨密度水平明顯降低,且均明顯低于同齡非肝硬化對照組,骨質(zhì)疏松癥發(fā)生率明顯高于對照組。肝硬化患者隨著肝功能嚴重程度加重,骨質(zhì)疏松發(fā)生率呈上升趨勢。PBC肝硬化患者較非PBC肝硬化患者更易發(fā)生骨質(zhì)疏松癥。
[Abstract]:Background and purpose: Osteoporosis (OP) is a skeletal complication of patients with cirrhosis, which often has no obvious symptoms. If it is not treated in time, it will increase the risk of fracture and affect the quality of life of the patients. In recent years, foreign studies have shown that cirrhosis is a risk factor for OP, but the incidence of OP in patients with cirrhosis is different, and the liver hard in China is hard. There are more patients, but the current domestic study of the incidence of cirrhosis with OP lacks large sample data. This study aims to review the correlation of OP in cirrhosis patients by examining the bone mineral density (BMD) and 25- hydroxyvitamin D[25 (OH) D] levels in cirrhosis patients. Methods: This study was finally included in December -2016 year in Jilin in December 2014. 280 cases of liver cirrhosis hospitalized in the first hospital of the first hospital of the University were studied, including 168 (60%) men (60%), 112 women (40%), age 34-71, and the average age was 55.48 + 9.06 years. All patients were measured by double energy X-ray absorption method and the BMD level of the lumbar vertebra (waist 1-4) and femur neck, and the liquid chromatography tandem mass spectrometry was used to detect the serum 25 (OH) D 280 hospitalized patients with non liver disease matched by the same age in our hospital were selected as the control group. According to the cause, the subjects were divided into primary biliary cirrhosis, namely group PBC (40 cases) and non primary biliary cirrhosis group, that is, non PBC group (240 cases), and non PBC group included hepatitis B cirrhosis group (HBV group, 110 cases), hepatitis C liver cirrhosis group. (group HCV, 80 cases), and alcohol liver cirrhosis group (group ALD, 50 cases). According to the severity of liver cirrhosis, according to the liver function Child-Pugh classification A, B, C, the subjects were divided into A group, B group and C group. The BMD, 25 (OH) D level and occurrence of 1280 cases of liver cirrhosis were compared. 0): 280 cases in the normal control group, 29 cases were OP, and the incidence of OP was 10.36% (29/280). The incidence of OP in the cirrhosis group was significantly higher than that of the control group. The lumbar BMD:L1-4,0.757 + 0.154 (g/cm~2) and the femoral neck 0.650 + 0.147 (g/cm~2) were significantly lower than that of the normal control group, 0.988 + 0.145 (g/cm~2) and 0.843 + (g/cm~2), and the cirrhosis group 25 (OH) D water. The level of 17.89 + 12.88 ng/ml was significantly lower than that of the control group (28.01 + 11.89 (ng/ml)) (p0.001), and the levels of BMD and 25 (OH) D in the cirrhosis group and the control group were all statistically different in.2. The cirrhosis group was divided into Child-Pugh classification groups, and the patients were divided into A, B, C three group, 0.843 + 0.169, 0.684 + 0.153, 0.597 + 0., respectively. 161 (g/cm~2); the femoral neck BMD was 0.721 + 0.178 (g/cm~2), 0.587 + 0.166 (g/cm~2) and 0.501 + 0.158 (g/cm~2). From a to C, the patients' BMD showed a downward trend, and the BMD level of C level was significantly lower than that of class a.A group, B group, 20.89 + 11.79, 19.24 + 11.93, 12.49 +. The level of C 25 (OH) D was significantly lower than that of 11,29,21 in a class a.A-C group, and the occurrence rate of OP was 14.10%, 22.31%, 29.17% respectively. The incidence of OP increased gradually from a to C grade, and the OP incidence of C class was significantly higher than that of class A.3,40 cases, male 4, female 36, and average age: 56.11 + 11.38 years old. Of the 240 non PBC groups, 44 cases had OP, the incidence of OP was 18.33% (44/240), and the incidence of OP in PBC group was significantly higher than that in the non PBC group (p=0.001).PBC group BMD: lumbar L1-4,0.505 0.148 (g/cm~2), and the neck of the femur 0.424 + 0.132 (0.799 + 0.149) and femoral neck 0.688 + 0.133 respectively. The degree was 18.99 + 11.34 (ng/ml), which was lower than that of non PBC group (22.79 + 12.98), but there was no statistical difference between the two groups.4, PBC, HBV, HCV, and AMD group of lumbar vertebrae (L1-4) BMD were 0.505 + 0.148 (g/cm~2), 0.758 + 0.143 (g/cm~2), 0.713 + 0.151, 0.653 + 0.146, respectively. 0.157 (g/cm~2), 0.613 + 0.168 (g/cm~2), the age difference of each group was not statistically significant. After the analysis of variance and 22, the lumbar (L1-4) and the BMD of the femoral neck of group PBC were lower than the HBV group, HCV group and ALD group, while the BMD in non PBC group had no significant difference (P0.05) in the.40 cases, 17 cases were 42.50% (110); 110 The incidence of OP in 18 cases of HBV cirrhosis was 16.36% (18/110). Among 80 patients with HCV cirrhosis, 13 cases were OP, and the incidence of OP was 16.25% (13/80); 13 of the 50 ALD patients were OP (13/50).HBV group, and there was no significant difference between the HCV group and the group of cirrhosis. And significantly higher than group HBV (p=0.001), group HCV (p=0.002), and no statistical difference between group ALD (p=0.099). Conclusion: the level of 25 (OH) D and bone mineral density in patients with liver cirrhosis was significantly lower than that of non cirrhosis control group, and the incidence of osteoporosis was significantly higher than that of the control group. The severity of liver function increased with the severity of liver function in the patients with liver cirrhosis. The incidence of osteoporosis is increasing..PBC patients with cirrhosis are more prone to osteoporosis than non PBC cirrhosis patients.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575.2;R580

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