慢性乙型肝炎病毒感染与骨质疏松症风险之间的关联：一项基于全国人口的研究。
Association Between Chronic Hepatitis B Virus Infection and Risk of Osteoporosis: A Nationwide Population-Based Study.
作者信息
Chen Chien-Hua, Lin Cheng-Li, Kao Chia-Hung
机构信息
From the Digestive Disease Center, Show-Chwan Memorial Hospital, Changhua (C-HC), Hungkuang University, Taichung (C-HC), Meiho University of Technology, Pingtung (C-HC), Management Office for Health Data, China Medical University Hospital (C-LL), College of Medicine (C-LL), Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK).
出版信息
Medicine (Baltimore). 2015 Dec;94(50):e2276. doi: 10.1097/MD.0000000000002276.
The effect of hepatitis B virus (HBV) infection on bone mineral density in patients without advanced liver disease remains unclear. Hence, we assessed the association between HBV infection and the risk of osteoporosis. From 2000 to 2011, patients older than 20 years with HBV infection were identified from the Longitudinal Health Insurance Database 2000. Of the 180,730 sampled patients, 36,146 and 144,584 patients were categorized into HBV infection and comparison cohorts, respectively. Compared with the comparison cohort, the HBV infection patients had a higher risk of osteoporosis (adjusted hazard ratio [aHR]: 1.14, 95% confidence interval [CI]: 1.03-1.25) after adjusting for age, sex, frequency of medical visits, and comorbidities of diabetes, hypertension, hyperlipidemia, heart failure, cirrhosis, chronic kidney disease, thyroid diseases, medication of steroid, PPI, warfarin, aspirin, and estrogen replacement therapy. The patients with HBV infection exhibited a 1.13-fold (95% CI = 1.03-1.25) higher risk of developing osteoporosis, but the risk of osteoporotic fracture was comparable between patients with HBV infection and the comparison cohort (aHR = 1.20, 95% CI = 0.77-1.86). The incidence of osteoporosis increased with the increment of age (age ≤ 49: aHR = 1; age 50-64: aHR = 5.67, 95% CI = 5.09-6.32; age ≧ 65: aHR = 13.3, 95% CI = 11.8-14.9) and coexisting cirrhosis (aHR = 1.62, 95% CI = 1.24-2.12). However, the osteoporosis risk contributed by HBV infection decreased with age and the age-specific risk analyses showed that patients with HBV infection exhibited the highest risk of osteoporosis than patients without HBV infection for the patients aged ≤49 (aHR = 1.42, 95% CI = 1.19-1.70). Furthermore, the osteoporosis risk contributed by HBV infection has decreased with the presence of comorbidity (aHR = 1.27, 95% CI = 1.09-1.48 vs aHR = 1.04, 95% CI = 0.91-1.15). HBV increases the risk of osteoporosis, but HBV infection may be less influential than other risk factors. Moreover, HBV has no detrimental effect on osteoporotic fracture in this study.
乙肝病毒（HBV）感染对无晚期肝病患者骨密度的影响尚不清楚。因此，我们评估了HBV感染与骨质疏松风险之间的关联。2000年至2011年，从2000年纵向健康保险数据库中识别出年龄超过20岁的HBV感染患者。在180,730名抽样患者中，分别有36,146名和144,584名患者被归入HBV感染队列和对照队列。在校正年龄、性别、就诊频率以及糖尿病、高血压、高脂血症、心力衰竭、肝硬化、慢性肾脏病、甲状腺疾病、类固醇药物、质子泵抑制剂、华法林、阿司匹林和雌激素替代疗法等合并症后，与对照队列相比，HBV感染患者发生骨质疏松的风险更高（校正风险比[aHR]：1.14，95%置信区间[CI]：1.03 - 1.25）。HBV感染患者发生骨质疏松的风险高出1.13倍（95% CI = 1.03 - 1.25），但HBV感染患者与对照队列之间骨质疏松性骨折的风险相当（aHR = 1.20，95% CI = 0.77 - 1.86）。骨质疏松的发病率随年龄增长（年龄≤49岁：aHR = 1；年龄50 - 64岁：aHR = 5.67，95% CI = 5.09 - 6.32；年龄≥65岁：aHR = 13.3，95% CI = 11.8 - 14.9）和并存肝硬化（aHR = 1.62，95% CI = 1.24 - 2.12）而增加。然而，HBV感染导致的骨质疏松风险随年龄降低，按年龄分层的风险分析显示，对于年龄≤49岁的患者，HBV感染患者发生骨质疏松的风险高于未感染HBV的患者（aHR = 1.42，95% CI = 1.19 - 1.70）。此外，合并症的存在使HBV感染导致的骨质疏松风险降低（aHR = 1.27，95% CI = 1.09 - 1.48 对比 aHR = 1.04，95% CI = 0.91 - 1.15）。HBV增加了骨质疏松的风险，但HBV感染的影响可能小于其他风险因素。此外，在本研究中HBV对骨质疏松性骨折无有害影响。
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