长期克罗恩病患者血清和骨骼维生素K水平低下：克罗恩病骨质疏松的另一致病因素？
Low serum and bone vitamin K status in patients with longstanding Crohn's disease: another pathogenetic factor of osteoporosis in Crohn's disease?
作者信息
Schoon E J, Müller M C, Vermeer C, Schurgers L J, Brummer R J, Stockbrügger R W
机构信息
Department of Gastroenterology and Hepatology, University Hospital Maastricht, Maastricht, the Netherlands.
出版信息
Gut. 2001 Apr;48(4):473-7. doi: 10.1136/gut.48.4.473.
BACKGROUND
A high prevalence of osteoporosis is reported in Crohn's disease. The pathogenesis is not completely understood but is probably multifactorial. Longstanding Crohn's disease is associated with a deficiency of fat soluble vitamins, among them vitamin K. Vitamin K is a cofactor in the carboxylation of osteocalcin, a protein essential for calcium binding to bone. A high level of circulating uncarboxylated osteocalcin is a sensitive marker of vitamin K deficiency.
AIMS
To determine serum and bone vitamin K status in patients with Crohn's disease and to elucidate its relationship with bone mineral density.
METHODS
Bone mineral density was measured in 32 patients with longstanding Crohn's disease and small bowel involvement, currently in remission, and receiving less than 5 mg of prednisolone daily. Serum levels of vitamins D and K, triglycerides, and total immunoreactive osteocalcin, as well as uncarboxylated osteocalcin ("free" osteocalcin) were determined. The hydroxyapatite binding capacity of osteocalcin was calculated. Data were compared with an age and sex matched control population.
RESULTS
Serum vitamin K levels of CD patients were significantly decreased compared with normal controls (p<0.01). "Free" osteocalcin was higher and hydroxyapatite binding capacity of circulating osteocalcin was lower than in matched controls (p<0.05 and p<0.001, respectively), indicating a low bone vitamin K status in Crohn's disease. In patients, an inverse correlation was found between "free" osteocalcin and lumbar spine bone mineral density (r=-0.375, p<0.05) and between "free" osteocalcin and the z score of the lumbar spine (r=-0.381, p<0.05). Multiple linear regression analysis showed that "free" osteocalcin was an independent risk factor for low bone mineral density of the lumbar spine whereas serum vitamin D was not.
CONCLUSIONS
The finding that a poor vitamin K status is associated with low bone mineral density in longstanding Crohn's disease may have implications for the prevention and treatment of osteoporosis in this disorder.
背景
据报道，克罗恩病患者骨质疏松症的患病率较高。其发病机制尚未完全明确，但可能是多因素的。长期的克罗恩病与脂溶性维生素缺乏有关，其中包括维生素K。维生素K是骨钙素羧化过程中的一种辅助因子，骨钙素是一种使钙结合到骨骼上所必需的蛋白质。高水平的循环未羧化骨钙素是维生素K缺乏的敏感标志物。
目的
测定克罗恩病患者血清和骨骼中的维生素K状态，并阐明其与骨密度的关系。
方法
对32例长期患有克罗恩病且累及小肠、目前处于缓解期且每日服用泼尼松龙少于5mg的患者测量骨密度。测定血清维生素D和K水平、甘油三酯、总免疫反应性骨钙素以及未羧化骨钙素（“游离”骨钙素）。计算骨钙素的羟基磷灰石结合能力。将数据与年龄和性别匹配的对照人群进行比较。
结果
与正常对照组相比，克罗恩病患者的血清维生素K水平显著降低（p<0.01）。“游离”骨钙素高于匹配对照组，而循环骨钙素的羟基磷灰石结合能力低于匹配对照组（分别为p<0.05和p<0.001），表明克罗恩病患者骨骼中的维生素K状态较低。在患者中，“游离”骨钙素与腰椎骨密度之间呈负相关（r=-0.375，p<0.05），“游离”骨钙素与腰椎z评分之间也呈负相关（r=-0.381，p<0.05）。多元线性回归分析表明，“游离”骨钙素是腰椎骨密度低的独立危险因素，而血清维生素D则不是。
结论
长期克罗恩病患者维生素K状态不佳与骨密度低有关这一发现，可能对该疾病骨质疏松症的预防和治疗具有重要意义。
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