Bukhari Tayyaba, Jafri Lena, Majid Hafsa, Khan Aysha Habib H, Siddiqui Imran
Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2021 Apr 13;13(4):e14479. doi: 10.7759/cureus.14479.
Introduction Hepatic osteodystrophy is an osteoporotic bone disease that occurs in chronic liver disease patients. The global prevalence of osteoporosis in patients with chronic liver disease is 30% to 40%. The pathogenesis of hepatic bone disease is not clear, but it occurs due to unstable bone remodeling with increased bone resorption and decreases bone formation. There has been an interest in determining the clinical utility of bone turnover markers (BTMs) in the assessment of osteoporosis in chronic liver patients. Methods This was a cross-sectional study conducted in patients with chronic liver disease at the section of chemical pathology, department of pathology and laboratory medicine, Aga Khan University (AKU). A total of 50 patients with age >8 years and a history of liver disease >6 months were recruited from January to October 2019. Liver function tests, i.e. aspartate aminotransferase (AST), alanine transaminase (ALT), albumin, and bilirubin, along with clinical signs of liver disease chronicity, were noted. The samples for BTMs, i.e. total serum alkaline phosphatase (ALP) and serum C-terminal telopeptide of type-1 collagen (CTX) were withdrawn and analyzed on Microlab (ELItech Group, Puteaux, France) and ADVIA Centaur (Siemens Diagnostics, NY), respectively. Results The majority of patients were males (n=34, 68%). Twenty-four (48%) patients suffered from fibrosis while 26 (52%) were without fibrosis. Median platelet count (68×10/L (102.5-50)) and median cholesterol levels (102.5 mg/dl (147-99.5)) were decreased, whereas gamma-glutamyl transferase (GGT) levels were higher in the fibrosis group as compared to the non-fibrosis group. The median levels of total ALP were 91.5 IU/L (103-82), and the median levels of CTX were 0.24 pg/ml (0.34-0.21). Conclusion In the present study, no significant difference was found in the BTMs of patients with and without chronic liver disease (CLD). However, there was a positive and significant correlation of BTMs, particularly CTX with age, bilirubin levels, and hepatomegaly.
引言 肝性骨营养不良是一种发生于慢性肝病患者的骨质疏松性骨病。慢性肝病患者中骨质疏松的全球患病率为30%至40%。肝性骨病的发病机制尚不清楚，但它是由于骨重塑不稳定，骨吸收增加和骨形成减少所致。人们一直对确定骨转换标志物（BTMs）在评估慢性肝病患者骨质疏松症方面的临床效用感兴趣。
方法 这是一项在阿迦汗大学（AKU）病理与检验医学系化学病理科对慢性肝病患者进行的横断面研究。2019年1月至10月共招募了50名年龄大于8岁且有肝病病史超过6个月的患者。记录肝功能检查，即天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、白蛋白和胆红素，以及肝病慢性化的临床体征。分别采集用于检测BTMs的样本，即总血清碱性磷酸酶（ALP）和血清I型胶原C端肽（CTX），并在Microlab（法国皮托的ELItech集团）和ADVIA Centaur（纽约的西门子诊断公司）上进行分析。
结果 大多数患者为男性（n = 34，68%）。24名（48%）患者患有纤维化，而26名（52%）患者没有纤维化。纤维化组的血小板计数中位数（68×10/L（102.5 - 50））和胆固醇水平中位数（102.5 mg/dl（147 - 99.5））降低，而γ-谷氨酰转移酶（GGT）水平高于非纤维化组。总ALP的中位数水平为91.5 IU/L（103 - 82），CTX的中位数水平为0.24 pg/ml（0.34 - 0.21）。
结论 在本研究中，慢性肝病（CLD）患者和非慢性肝病患者的BTMs未发现显著差异。然而，BTMs，尤其是CTX与年龄、胆红素水平和肝肿大呈正相关且具有显著性。
