本文關(guān)鍵詞： 炎癥性腸病 骨質(zhì)疏松 骨代謝 骨密度　出處：《復(fù)旦大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的炎癥性腸病(inflammatory bowel disease, IBD)是一類病因尚未明確的慢性復(fù)發(fā)性腸道炎癥性疾病,包括潰瘍性結(jié)腸炎(ulcerative colitis, UC)和克羅恩病(Crohn's disease, CD)。近年來,IBD在我國的發(fā)病逐年上升,成為消化系統(tǒng)的常見疾病之一。越來越多的證據(jù)表明,IBD患者的骨質(zhì)疏松發(fā)生率顯著高于正常健康人群,IBD并發(fā)骨質(zhì)疏松的相關(guān)研究也日益受到關(guān)注。了解IBD患者的骨代謝及骨密度情況,明確IBD并發(fā)骨質(zhì)疏松的危險因素,將有助于IBD患者并發(fā)骨質(zhì)疏松及骨折風(fēng)險的早期預(yù)防和治療。本研究通過分析IBD患者性別、年齡、體重指數(shù)(BMI)、病程、疾病活動度、病變部位、相關(guān)血清生物學(xué)指標(biāo)及糖皮質(zhì)激素應(yīng)用等與骨質(zhì)疏松發(fā)病的關(guān)系,探討IBD患者骨密度減低的危險因素。方法以華東醫(yī)院50例IBD患者為研究對象,以髖關(guān)節(jié)和股骨頸骨密度T值為評估骨密度情況的指標(biāo)；采用獨(dú)立樣本t檢驗(yàn)或卡方檢驗(yàn)比較UC和CD患者之間骨代謝相關(guān)血清生物學(xué)指標(biāo)、骨密度值及骨密度減低發(fā)生率的差異,比較骨密度減低者與骨量正常者之間的骨代謝指標(biāo)、年齡、性別、病程等因素的差異；采用Spearman相關(guān)分析來分析骨代謝血清指標(biāo)、年齡、BMI、病程與骨密度T值的相關(guān)性。采用logistic回歸分析IBD患者骨密度減低的危險因素。應(yīng)用統(tǒng)計學(xué)軟件SPSS 19.0進(jìn)行統(tǒng)計分析,P0.05表示差異有統(tǒng)計學(xué)意義。結(jié)果50例IBD(包括32例UC和18例CD)患者骨密度減低的發(fā)病率為70.0%,其中骨量減少者28例(56.0%),骨質(zhì)疏松者7例(14.0%)。32例UC患者中,骨量減少者16例(50.0%),骨質(zhì)疏松者6例(18.8%)；18例CD患者中,骨量減少12例(66.7%),骨質(zhì)疏松1例(5.6%)；UC組和CD組骨密度情況差異無顯著意義(x2=2.050,P=0.359)。15例骨量正常的IBD患者的平均年齡為(45.3±13.7)歲,35例骨密度減低者平均年齡為(57.1±14.8)歲,差異有顯著意義(t=-2.627,P=0.012)。UC患者的年齡與髖關(guān)節(jié)T值(r=-0.457,P=-0.009)及股骨頸T值(r=-0.554,P=0.001)呈顯著負(fù)相關(guān)。增齡是IBD患者骨密度減低的危險因素,但預(yù)測性較弱(OP=1.096,95% CI(1.022,1.176),P=0.010)。在28例骨量減少的IBD患者中,女性的平均年齡明顯大于男性((63.0±10.7)歲vS.(46.9±12.4)歲,t=-3.593,P=0.001)。女性是IBD患者骨密度減低的保護(hù)因素(OR=0.074,95% CI (0.008,0.675),P=0.021)。骨密度減低的IBD患者的血清ALP水平顯著高于骨量正常者((78.5±28.8) U/L vs. (62.2±16.7) U/L,t=2.037,p=0.047)。UC患者的血清ALP水平與髖關(guān)節(jié)T值(r=-0.431,P=0.014)、股骨頸T值(r=-0.437,P=O.012)均呈顯著負(fù)相關(guān)。CD患者的血清ALP水平僅與股骨頸T值(r=-0.475,P=0.046)呈顯著負(fù)相關(guān)。結(jié)論本院IBD患者骨密度減低的發(fā)病率較高。IBD中骨密度減低者的血清ALP水平顯著高于骨量正常者；IBD患者血清ALP水平與骨密度值呈負(fù)相關(guān)；提示骨密度減低的IBD患者骨轉(zhuǎn)換可能較活躍。UC患者年齡與骨密度T值呈顯著負(fù)相關(guān);年齡是IBD患者骨密度減低的獨(dú)立危險因素。女性是IBD患者骨密度減低的保護(hù)因素。尚不明確體重指數(shù)、病程、疾病嚴(yán)重程度、病變部位、使用GCs以及血鈣、血磷、25-(OH)D濃度與IBD患者骨密度的關(guān)系。
[Abstract]:The purpose of inflammatory bowel disease (inflammatory bowel, disease, IBD) is a kind of unknown etiology of chronic recurrent inflammatory bowel disease, including ulcerative colitis (ulcerative colitis, UC) and Crohn's disease (Crohn's disease, CD). In recent years, IBD incidence increased year by year in China, has become one of the common diseases of digestive system. More and more evidence that the incidence of osteoporosis in patients with IBD was significantly higher than that in normal healthy people, IBD related research of osteoporosis is also increasingly concerned. To understand the bone metabolism and bone density in patients with IBD, IBD and the risk factors of osteoporosis, there will be helpful to early prevention and treatment of IBD patients osteoporosis and fracture risk. Through the analysis of IBD patients with gender, age, body mass index (BMI), disease duration, disease activity, lesion, serum biological markers and glucocorticoid The relationship between hormone application and the incidence of osteoporosis, risk factors of bone mineral density in patients with IBD. Methods to reduce Huadong Hospital 50 cases of IBD patients as the research object, to evaluate the bone density index to hip and femoral neck BMD T value; by using independent sample t test or chi square test for comparison between UC and CD patients with bone metabolism of serum biochemical markers and bone mineral density, bone density to reduce the incidence of differences in bone metabolic markers, comparison between bone mineral density and bone mass reduction of normal age, gender differences, duration and other factors; using Spearman correlation analysis to analyze the serum bone metabolism index, age, duration of BMI, correlation bone mineral density and T value. The logistic regression analysis of risk factors of bone mineral density in patients with decreased IBD. SPSS 19 software was used for statistical analysis, P0.05 said the difference was statistically significant. Results 50 cases of IBD (including 32 渚婾C鍜，

本文編號：1495706