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肝硬化中影响骨密度的因素。

The factors affecting bone density in cirrhosis.

作者信息

Hajiabbasi Asghar, Shafaghi Afshin, Fayazi Haniyeh Sadat, Shenavar Masooleh Irandokht, Hedayati Emami Mohammad Hassan, Ghavidel Parsa Pooneh, Amir Maafi Alireza

机构信息

Guilan Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.

Gasteroenterology and Liver Disease Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.

出版信息

Hepat Mon. 2015 Apr 25;15(4):e26871. doi: 10.5812/hepatmon.15(4)2015.26871. eCollection 2015 Apr.

Abstract

BACKGROUND

Bone loss is common in cirrhosis. However, the prevalence of osteopenia and osteoporosis has been heterogeneous in different reports. Reduction in bone formation with or without increase in bone resorption appears to be responsible for bone loss in these patients.

OBJECTIVES

We aimed to investigate bone loss in patients with cirrhosis at different anatomical sites and key factors that might affect it.

PATIENTS AND METHODS

In this cross-sectional study, 97 patients with cirrhosis who were referred to Razi Hospital, Rasht, Iran, from 2008 to 2010, were studied. Cirrhosis was diagnosed using biopsy and/or clinical and paraclinical findings. Bone mineral densitometry was done in L2 through L4 lumbar spine (LS) and femoral neck (FN), using dual-energy X-ray absorptiometry (DEXA) (QDR 1000, Hologic DEXA Inc, Waltham, Massachusetts, the United States). Statistical analysis was performed using SPSS 18. A P value < 0.05 was considered statistically significant.

RESULTS

A total of 97 patients with cirrhosis (55.7% male) and the mean age of 51 ± 13 years and median body mass index (BMI) of 22.7 kg/m(2) were recruited over a two-year period. Etiologies of cirrhosis were hepatitis C (40.2%), hepatitis B (26.8%), cryptogenic (21.6%), and other causes (11.4%). Child A, B, and C, were seen in 16.5%, 47.4%, and 36.1% of patients, respectively. The DEXA results were abnormal in 78.4% of our participants (osteopenia, 45.4%; osteoporosis, 33%). BMI and calculated glomerular filtration rate (GFRc) had moderate positive and Child score had moderate negative significant correlation with T score in both anatomical sites. There was no significant association between abnormal DEXA and the causes of cirrhosis. The univariate analysis showed that the risk of abnormal results in DEXA was significantly higher in those with low BMI, current smoking, higher Child score, and low GFRc; however, in multivariate analysis, the abnormal results were more frequent in those with lower vitamin D, higher Child score, and less GFRc.

CONCLUSIONS

Abnormal DEXA was highly prevalent among patients with cirrhosis. The risk of this finding was increased by lower vitamin D levels, advanced disease, and impaired renal function.

摘要

背景

骨质流失在肝硬化患者中很常见。然而,不同报告中骨质疏松症和骨质减少症的患病率存在差异。这些患者的骨质流失似乎是由骨形成减少伴或不伴有骨吸收增加所致。

目的

我们旨在研究肝硬化患者不同解剖部位的骨质流失情况以及可能影响骨质流失的关键因素。

患者与方法

在这项横断面研究中,对2008年至2010年转诊至伊朗拉什特市拉齐医院的97例肝硬化患者进行了研究。通过活检和/或临床及辅助检查结果诊断肝硬化。使用双能X线吸收法(DEXA)(QDR 1000,美国马萨诸塞州沃尔瑟姆市Hologic DEXA公司)对L2至L4腰椎(LS)和股骨颈(FN)进行骨密度测定。使用SPSS 18进行统计分析。P值<0.05被认为具有统计学意义。

结果

在两年期间共纳入97例肝硬化患者(男性占55.7%),平均年龄为51±13岁,中位体重指数(BMI)为22.7kg/m²。肝硬化的病因包括丙型肝炎(40.2%)、乙型肝炎(26.8%)、隐源性(21.6%)和其他原因(11.4%)。分别有16.5%、47.4%和36.1%的患者为Child A、B和C级。78.4%的参与者DEXA结果异常(骨质减少症占45.4%;骨质疏松症占33%)。在两个解剖部位,BMI和计算的肾小球滤过率(GFRc)与T评分呈中度正相关,Child评分与T评分呈中度负相关。DEXA异常与肝硬化病因之间无显著关联。单因素分析显示,BMI低、当前吸烟、Child评分高和GFRc低的患者DEXA结果异常的风险显著更高;然而,多因素分析显示,维生素D水平较低、Child评分较高和GFRc较低的患者异常结果更为常见。

结论

DEXA异常在肝硬化患者中非常普遍。维生素D水平降低、疾病进展和肾功能受损会增加出现这种情况的风险。

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