长期吸入糖皮质激素治疗的慢性阻塞性肺疾病患者的矿物质状况

Buyukkaplan U Sebnem, Akkaya Ahmet, Yildiz Mustafa, Bircan Ahmet, Aksoy Dogan Alev, Ozturk Onder

Department of Prosthetic Dentistry, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey.

J Prosthodont. 2008 Aug;17(6):462-7. doi: 10.1111/j.1532-849X.2008.00334.x. Epub 2008 Jun 28.

PURPOSE

The aim of this study was to determine the mineral status of mandibles, femurs, and spines in chronic obstructive pulmonary disease (COPD) patients under long-term inhaled corticosteroid therapy.

MATERIALS AND METHODS

Pulmonary function tests were conducted on patients (n = 30) with COPD under inhaled corticosteroid therapy for at least 1 year. The results were compared to sex- and age-matched controls (n = 30). Analyses of blood gases were also carried out relative to COPD, and bone mineral densities (BMD) of the mandible, lumbar spine, femoral neck, trochanter, and Ward's triangle were also measured by dual-energy X-ray absorptiometry (DEXA). Levels of serum osteocalcin, alkaline phosphatase, calcium, phosphorus, and cortisol were also assessed.

RESULTS

In accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria, 8 of the COPD patients had moderate, 11 patients had severe, and 11 patients had very severe forms of the disease. All BMD measurements were lower in the COPD patients than in the control group. The serum osteocalcin levels in COPD patients were significantly lower than those in the control group (p < 0.0001). Serum calcium (p < 0.004) and cortisol levels (p < 0.026) in the COPD patients were also significantly lower than those in the control subjects. Although serum alkaline phosphatase level was higher and the phosphorus level was lower in the treatment group than in the control group, the differences were not statistically significant.

CONCLUSION

Regular evaluation of the biochemical markers of bone metabolism and BMD would be helpful for detecting any detrimental changes of bone in COPD patients under long-term inhaled corticosteroid therapy. In this study, mandibular BMD was observed to be lower in COPD patients under long-term inhaled corticosteroid therapy than in healthy subjects. Thus, dental implant treatment may require preventive measures in COPD patients under long-term inhaled corticosteroid therapy.

目的

本研究旨在确定长期吸入糖皮质激素治疗的慢性阻塞性肺疾病（COPD）患者下颌骨、股骨和脊柱的矿物质状况。

材料与方法

对至少接受吸入糖皮质激素治疗1年的COPD患者（n = 30）进行肺功能测试。将结果与性别和年龄匹配的对照组（n = 30）进行比较。还针对COPD进行了血气分析，并通过双能X线吸收法（DEXA）测量下颌骨、腰椎、股骨颈、大转子和Ward三角区的骨密度（BMD）。还评估了血清骨钙素、碱性磷酸酶、钙、磷和皮质醇水平。

结果

根据慢性阻塞性肺疾病全球倡议标准，8例COPD患者病情为中度，11例为重度，11例为极重度。所有COPD患者的BMD测量值均低于对照组。COPD患者的血清骨钙素水平显著低于对照组（p < 0.0001）。COPD患者的血清钙水平（p < 0.004）和皮质醇水平（p < 0.026）也显著低于对照组。尽管治疗组的血清碱性磷酸酶水平较高而磷水平较低，但差异无统计学意义。