原发性硬化性胆管炎患者的骨病：患病率、严重程度及病情进展预测
Bone disease in patients with primary sclerosing cholangitis: prevalence, severity and prediction of progression.
作者信息
Angulo P, Therneau T M, Jorgensen A, DeSotel C K, Egan K S, Dickson E R, Hay J E, Lindor K D
机构信息
Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
出版信息
J Hepatol. 1998 Nov;29(5):729-35. doi: 10.1016/s0168-8278(98)80253-5.
BACKGROUND/AIMS: Osteopenia is a common complication in some chronic cholestatic liver diseases. Our aims were to determine the prevalence and severity of bone disease in patients with primary sclerosing cholangitis; and identify risk factors to predict the presence and progression of osteopenia.
METHODS
Eighty-one patients involved in a randomized trial of ursodeoxycholic acid were analyzed. Bone mineral density of the lumbar spine was determined at entry and at annual intervals.
RESULTS
Bone mineral density of the lumber spine in primary sclerosing cholangitis patients was significantly lower than expected when compared to normal values adjusted for age, sex and ethnic group at entry (p<0.005), and after 1 year (p<0.05), 2 years (p<0.05), 4 years (p<0.005) and 5 years of follow-up (p<0.005). Seven patients (8.6%) had bone mineral density of the lumber spine below the fracture threshold at entry. These patients were significantly older, had a longer duration of inflammatory bowel disease and more advanced primary sclerosing cholangitis. The rate of bone loss in primary sclerosing cholangitis patients and expected in normal controls was 0.01+/-0.02 g x cm(-2) x year(-1) and 0.003+/-0.003 g x cm(-2) x year(-1), respectively (p = NS), and was similar in patients receiving placebo and ursodeoxycholic acid. Age was the only variable inversely related with baseline bone mineral density of the lumber spine (p<0.0001). None of the variables predicted progression of the bone disease.
CONCLUSIONS
Severe osteoporosis occurs in few patients with primary sclerosing cholangitis, but it should be suspected in patients with longer duration of inflammatory bowel disease and more advanced liver disease. Its presence, severity and progression cannot be accurately evaluated by routine clinical, biochemical, or histological variables. Ursodeoxycholic acid does not affect the rate of bone loss in primary sclerosing cholangitis.
背景/目的：骨质减少是一些慢性胆汁淤积性肝病的常见并发症。我们的目的是确定原发性硬化性胆管炎患者骨病的患病率和严重程度；并识别预测骨质减少存在和进展的危险因素。
方法
对参与熊去氧胆酸随机试验的81例患者进行分析。在入组时及每年测定腰椎的骨密度。
结果
与根据年龄、性别和种族调整后的正常数值相比，原发性硬化性胆管炎患者入组时（p<0.005）、随访1年（p<0.05）、2年（p<0.05）、4年（p<0.005）和5年（p<0.005）时腰椎骨密度显著低于预期。7例患者（8.6%）入组时腰椎骨密度低于骨折阈值。这些患者年龄显著更大，炎性肠病病程更长，原发性硬化性胆管炎病情更严重。原发性硬化性胆管炎患者的骨丢失率和正常对照组预期的骨丢失率分别为0.01±0.02 g×cm⁻²×年⁻¹和0.003±0.003 g×cm⁻²×年⁻¹（p=无显著性差异），接受安慰剂和熊去氧胆酸的患者相似。年龄是与腰椎基线骨密度呈负相关的唯一变量（p<0.0001）。没有变量能够预测骨病的进展。
结论
少数原发性硬化性胆管炎患者会发生严重骨质疏松，但炎性肠病病程较长和肝病较严重的患者应怀疑有此病。其存在、严重程度和进展不能通过常规临床、生化或组织学变量准确评估。熊去氧胆酸不影响原发性硬化性胆管炎的骨丢失率。
Zotero 插件