Goto Kenichi, Ogawa Emiko, Shimizu Kaoruko, Makita Hironi, Suzuki Hidenobu, Kawata Yoshiki, Niki Noboru, Nishimura Masaharu, Nakano Yasutaka
Division of Respiratory Medicine, Department of Medicine, Shiga University of Medical Science, Otsu, Shiga.
Department of Pulmonary Medicine, Takatsuki Red Cross Hospital, Takatsuki, Osaka.
Int J Chron Obstruct Pulmon Dis. 2018 Feb 20;13:639-644. doi: 10.2147/COPD.S153750. eCollection 2018.
Osteoporosis is a well-known comorbidity in COPD. It is associated with poor health status and prognosis. Although the exact pathomechanisms are unclear, osteoporosis is suggested to be either a comorbidity due to shared risk factors with COPD or a systematic effect of COPD with a cause-effect relationship. This study aimed to evaluate whether progression of osteoporosis is synchronized with that of COPD.
Data from 103 patients with COPD included in the Hokkaido COPD cohort study were analyzed. Computed tomography (CT) attenuation values of thoracic vertebrae 4, 7, and 10 were measured using custom software, and the average value (average bone density; ABD) was calculated. The percentage of low attenuation volume (LAV%) for each patient was also calculated for evaluation of emphysematous lesions. Annual change in thoracic vertebral CT attenuation, which is strongly correlated with dual-energy X-ray absorptiometry-measured bone mineral density, was compared with that in FEV or emphysematous lesions.
In the first CT data set, ABD was significantly correlated with age (=-0.331; =0.0006), body mass index (BMI; =0.246; =0.0136), St George's Respiratory Questionnaire (SGRQ) activity score (=-0.248; =0.0115), eosinophil count (=0.229; =0.0198), and LAV% (=-0.372; =0.0001). However, ABD was not associated with FEV. After adjustment for age, BMI, SGRQ activity score, and eosinophil count, no significant relationship was found between ABD and LAV%. Annual change in ABD was not associated with annual change in LAV% or FEV.
Progression of osteoporosis and that of COPD are not directly related or synchronized with each other.
骨质疏松是慢性阻塞性肺疾病（COPD）中一种众所周知的合并症。它与健康状况不佳和预后不良相关。尽管确切的发病机制尚不清楚，但骨质疏松被认为要么是由于与COPD有共同风险因素导致的合并症，要么是COPD的一种系统性效应，存在因果关系。本研究旨在评估骨质疏松的进展是否与COPD的进展同步。
分析了北海道COPD队列研究中纳入的103例COPD患者的数据。使用定制软件测量第4、7和10胸椎的计算机断层扫描（CT）衰减值，并计算平均值（平均骨密度；ABD）。还计算了每位患者的低衰减体积百分比（LAV%）以评估肺气肿病变。将与双能X线吸收法测量的骨密度密切相关的胸椎CT衰减的年度变化与第一秒用力呼气容积（FEV）或肺气肿病变的年度变化进行比较。
在第一组CT数据中，ABD与年龄（r = -0.331；P = 0.0006）、体重指数（BMI；r = 0.246；P = 0.0136）、圣乔治呼吸问卷（SGRQ）活动评分（r = -0.248；P = 0.0115）、嗜酸性粒细胞计数（r = 0.229；P = 0.0198）和LAV%（r = -0.372；P = 0.0001）显著相关。然而，ABD与FEV无关。在对年龄、BMI、SGRQ活动评分和嗜酸性粒细胞计数进行校正后，未发现ABD与LAV%之间存在显著关系。ABD的年度变化与LAV%或FEV的年度变化无关。
骨质疏松的进展与COPD的进展彼此不直接相关或不同步。
