Stellon A J, Davies A, Compston J, Williams R
Gastroenterology. 1985 Nov;89(5):1078-83. doi: 10.1016/0016-5085(85)90212-4.
To determine the frequency of osteoporosis in patients with autoimmune chronic active hepatitis who are maintained on corticosteroids, both cortical and trabecular bone loss were studied in a group of 36 patients. A significant decrease in both the total trabecular bone volume (p = 0.005) and cortical plate thickness (p = 0.01) of iliac crest biopsy specimens was found in the patients with chronic active hepatitis. Bone mineral content of the radial metaphysis, a site composed of both cortical and trabecular bone, was found to be significantly decreased (p = 0.05). However, no statistical reduction in cortical bone mass of the radial diaphysis and second metacarpal was detected. Altogether, 47% of patients had evidence of either excessive trabecular or cortical bone loss, or both, as judged by histologic and radiologic criteria. The presence of cirrhosis at the time of diagnosis or subsequently did not appear to lead to greater loss of bone mass. However, a weak inverse correlation was found between the product of mean dose and duration of corticosteroid therapy and both the trabecular bone volume and the cortical plate thickness of the iliac crest biopsy specimens. Based on these results, patients with autoimmune chronic active hepatitis on low doses of prednisolone therapy may need to be treated with calcium and vitamin D at an early stage of their disease.
为了确定接受皮质类固醇治疗的自身免疫性慢性活动性肝炎患者骨质疏松症的发生率，对一组36例患者的皮质骨和小梁骨丢失情况进行了研究。慢性活动性肝炎患者髂嵴活检标本的小梁骨总体积（p = 0.005）和皮质板厚度（p = 0.01）均显著降低。桡骨近端干骺端的骨矿物质含量，该部位由皮质骨和小梁骨组成，也显著降低（p = 0.05）。然而，未检测到桡骨干和第二掌骨皮质骨量的统计学减少。根据组织学和放射学标准判断，共有47%的患者存在小梁骨或皮质骨过度丢失，或两者皆有。诊断时或随后出现肝硬化似乎并未导致更大的骨量丢失。然而，皮质类固醇治疗的平均剂量与疗程的乘积与髂嵴活检标本的小梁骨体积和皮质板厚度之间存在微弱的负相关。基于这些结果，接受低剂量泼尼松龙治疗的自身免疫性慢性活动性肝炎患者在疾病早期可能需要补充钙和维生素D进行治疗。
