Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Dig Dis Sci. 2011 Nov;56(11):3323-7. doi: 10.1007/s10620-011-1722-y. Epub 2011 May 15.
Patients with cirrhosis are more prone to develop metabolic bone disease. Scanty literature data are available on osteodystrophy in patients from India with noncholestatic liver diseases.
Patients diagnosed with cirrhosis were prospectively evaluated for bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry at the femoral neck, lumbar spine, and left forearm (distal radius). Correlation of BMD with age, sex, etiology of cirrhosis, Child's class, serum bilirubin, alkaline phosphatase (ALP), albumin, calcium, phosphate, 25-hydroxyvitamin D (25(OH)D), and parathyroid hormone (PTH) was studied.
The study group comprised 115 cirrhotic patients (107 males and 8 females). Etiology of cirrhosis was alcohol in 67 (58.2%) and viral in 48 (41.7%). Hepatitis B was diagnosed in 29 (25.2%) and hepatitis C in 19 (16.5%). Mean age was 49 (± 5.5) years. Prevalence of osteodystrophy was significantly higher in males than in females; 97.1% and 75% respectively (P = .038). Both alcoholic and viral groups had similar baseline characteristics except albumin levels. Child's class was B in 72 patients and C in 43. Low BMD was present in 97% of patients with alcoholic cirrhosis and 93.7% with viral cirrhosis (P > .05). Low BMD was present at the femoral neck in 80.8% of patients, lumbar spine in 77.3%, and forearm in 59.9%. PTH correlated negatively with BMD.
Osteodystrophy is common in alcoholic and viral cirrhosis patients.
肝硬化患者更容易发生代谢性骨病。关于非胆汁淤积性肝病患者的骨营养不良，印度的相关文献数据很少。
前瞻性评估了 115 例肝硬化患者（107 名男性和 8 名女性）的骨密度（BMD），采用双能 X 射线吸收法测量股骨颈、腰椎和左前臂（桡骨远端）的 BMD。研究了 BMD 与年龄、性别、肝硬化病因、Child 分级、血清胆红素、碱性磷酸酶（ALP）、白蛋白、钙、磷、25-羟维生素 D（25(OH)D）和甲状旁腺激素（PTH）的相关性。
该研究组包括 115 例肝硬化患者（67 例酒精性和 48 例病毒性）。乙型肝炎诊断为 29 例（25.2%），丙型肝炎 19 例（16.5%）。平均年龄为 49（±5.5）岁。男性骨营养不良的患病率明显高于女性；分别为 97.1%和 75%（P=0.038）。酒精性和病毒性两组除白蛋白水平外，其他基线特征相似。72 例患者为 Child 分级 B，43 例为 Child 分级 C。97%的酒精性肝硬化患者和 93.7%的病毒性肝硬化患者存在低 BMD（P>.05）。80.8%的患者股骨颈 BMD 降低，77.3%的患者腰椎 BMD 降低，59.9%的患者前臂 BMD 降低。PTH 与 BMD 呈负相关。
酒精性和病毒性肝硬化患者骨营养不良很常见。
