Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.
Calcif Tissue Int. 2012 Dec;91(6):423-9. doi: 10.1007/s00223-012-9653-y. Epub 2012 Oct 5.
Whether chronic hepatitis C virus (HCV) infection is a risk factor for the development of bone disease has long been controversial. For this reason, chronic HCV-infected participants (n = 69) were recruited into a prospective cohort study and underwent dual-energy X-ray absorptiometry for determination of bone mineral density (BMD). Fibrosis staging was evaluated according to the noninvasive index FIB-4. T scores at the femoral neck and lumbar spine were used as the primary outcome variables to assess the association between degree of liver disease and BMD. The study cohort was 41 % male with a mean age of 53.6 years. The mean BMD, Z score, and T score values of lumbar spine in chronic hepatitis C (CHC) patients were significantly lower than those in healthy controls (p < 0.001). The rate of osteoporosis for CHC patients aged 45-54 years was significantly higher than that of the control group (p = 0.011). Bone alkaline phosphatase and C-terminal cross-linking telopeptide of type I collagen levels were also significantly higher in CHC patients with reduced BMD. Patients with more advanced liver fibrosis had significantly lower BMD. In conclusion, reduced BMD is common in this population of chronic HCV-infected patients and associated with liver disease severity. This extrahepatic manifestation is probably secondary to increased bone turnover in osteodystrophy pathogenesis.
慢性丙型肝炎病毒（HCV）感染是否是骨病发展的危险因素一直存在争议。出于这个原因，招募了 69 名慢性 HCV 感染的参与者（n=69）进入前瞻性队列研究，并进行双能 X 射线吸收法测定骨矿物质密度（BMD）。纤维化分期根据无创指数 FIB-4 进行评估。股骨颈和腰椎的 T 评分作为主要观察指标，用于评估肝脏疾病严重程度与 BMD 的关系。研究队列中 41%为男性，平均年龄为 53.6 岁。慢性丙型肝炎（CHC）患者腰椎的平均 BMD、Z 评分和 T 评分明显低于健康对照组（p<0.001）。45-54 岁 CHC 患者的骨质疏松症发生率明显高于对照组（p=0.011）。BMD 降低的 CHC 患者的骨碱性磷酸酶和 I 型胶原 C 端交联肽水平也明显升高。肝纤维化程度更严重的患者的 BMD 明显降低。总之，在这群慢性 HCV 感染患者中，BMD 降低很常见，且与肝脏疾病的严重程度相关。这种肝外表现可能继发于骨质疏松症发病机制中骨转换的增加。
