Savic Z, Damjanov D, Curic N, Kovacev-Zavisic B, Hadnadjev L, Novakovic-Paro J, Nikolic S
Bratisl Lek Listy. 2014;115(9):573-8. doi: 10.4149/bll_2014_111.
Osteoporosis is seen in some 12-50 % patients with liver cirrhosis. Detrimental effects of alcohol are exerted directly on the bone cells and indirectly on hormones. Vitamin D is involved in osteoblast differentiation, bone matrix synthesis and bone mineralization, as well as in its decomposition. Vitamin D deficiency has been reported in about 2/3 patients with liver cirrhosis.
Determination of vitamin D status, bone metabolic activity and bone mass in patients with alcoholic liver cirrhosis (ALC).
Thirty male patients with ALC were investigated in the period October 2011- March 2012. Total vitamin D, parathormone, osteocalcin and CrossLaps were determined by the ECLIA method (electrochemiluminiscence immunoassay) using Elecsys 2010 analyzer. Bone mineral density was measured by means of dual-energy x-ray absorptiometry (DXA) using the Lunar Prodigy. Result analysis was performed using descriptive statistics and hypothesis testing, as well as nonparametric one-way analysis of variance, Kruskal-Wallis test, Mann-Whitney U-test, Pearson correlation coefficient.
Deficiency in vitamin D (< 50 nmol/l) was noted in 66.66 % patients, with highest prevalence in Child-Pugh C class patients (chi-square = 5.878, p < 0.05). Osteocalcin levels were below the lower limit of normal in 86.7 % patients. CrossLaps was increased in only 20 % patients, but a significant increase was noted in Child-Pugh C class patients. Osteoporosis was diagnosed in 20 % of patients, with no correlation with disease severity and vitamin D status.
Vitamin D deficiency is present in patients with ALC. Decrease in bone formation and bone mass is most probably multicausal (Tab. 2, Fig. 1, Ref. 30).
约12% - 50%的肝硬化患者患有骨质疏松症。酒精对骨细胞有直接损害作用，对激素有间接损害作用。维生素D参与成骨细胞分化、骨基质合成与骨矿化，以及其分解过程。据报道，约2/3的肝硬化患者存在维生素D缺乏。
测定酒精性肝硬化（ALC）患者的维生素D状况、骨代谢活性和骨量。
2011年10月至2012年3月期间对30例男性ALC患者进行了研究。使用Elecsys 2010分析仪通过电化学发光免疫分析（ECLIA）法测定总维生素D、甲状旁腺激素、骨钙素和交联C端肽。使用Lunar Prodigy通过双能X线吸收法（DXA）测量骨密度。采用描述性统计、假设检验以及非参数单因素方差分析、Kruskal - Wallis检验、Mann - Whitney U检验、Pearson相关系数进行结果分析。
66.66%的患者存在维生素D缺乏（< 50 nmol/l），在Child - Pugh C级患者中患病率最高（卡方 = 5.878，p < 0.05）。86.7%的患者骨钙素水平低于正常下限。仅20%的患者交联C端肽升高，但在Child - Pugh C级患者中有显著升高。20%的患者被诊断为骨质疏松症，与疾病严重程度和维生素D状况无关。
ALC患者存在维生素D缺乏。骨形成和骨量减少很可能是多因素导致的（表2，图1，参考文献30）。
