[1]王彭禾,汪小健,吴丛姿,等.血友病性关节炎与骨质疏松症的关系研究[J].中医正骨,2022,34(02):31-35+53.
　.The First Clinical Medical College of Zhejiang Chinese Medical University,Hangzhou 00,Zhejiang,et al.WANG Penghe1,WANG Xiaojian1,WU Congzi1,SHI Zhenyu1,JIN Hongting1,WANG Pinger1,TONG Peijian2[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(02):31-35+53.
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血友病性关节炎与骨质疏松症的关系研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年02期
页码:
31-35+53
栏目:
临床研究
出版日期:
2022-02-20

文章信息/Info

Title:
WANG Penghe1,WANG Xiaojian1,WU Congzi1,SHI Zhenyu1,JIN Hongting1,WANG Pinger1,TONG Peijian2
作者:
王彭禾1; 汪小健1; 吴丛姿1; 施振宇1; 金红婷1; 王萍儿1; 童培建2
1.浙江中医药大学第一临床医学院,浙江 杭州 310053; 2.浙江省中医院,浙江 杭州 310006
Author(s):
1.The First Clinical Medical College of Zhejiang Chinese Medical University; Hangzhou 310053; Zhejiang; China
2.Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China
关键词:
关节炎;  血友病A;  血友病B;  骨密度;  骨质疏松
Keywords:
arthritis;  hemophilia A;  hemophilia B;  bone density;  osteoporosis
摘要:
目的:探讨血友病性关节炎与骨质疏松症的关系。方法:回顾性分析2019年12月至2020年12月收治的40例男性血友病性关节炎患者(血友病性关节炎组)和60例门诊健康体检男性(健康体检组)的病例资料。比较2组受试者的血清骨代谢指标及血液生化指标,前者包括25-羟基维生素D、甲状旁腺激素、总Ⅰ型胶原氨基端前肽(total N-terminal propeptide of typeⅠcollagen,TPⅠNP)、骨钙素、降钙素、Ⅰ型胶原羧基端肽β特殊序列(β-C-terminal telopeptide of typeⅠcollagen,β-CTX),后者包括钙、磷、碱性磷酸酶(alkaline phosphatase,ALP)、超敏C反应蛋白(supersensitive C-reaction protein,SCRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR); 比较2组受试者的左侧股骨颈和腰椎(L1～L4)骨密度T值。根据血友病的病情程度将40例血友病性关节炎患者分为轻度、中度、重度3组,比较3组患者的左侧股骨颈和腰椎(L1～L4)骨密度T值。结果:①血清骨代谢指标。血友病性关节炎组的血清TPⅠNP、骨钙素、β-CTX含量均高于健康体检组[(76.8±31.1)ng·mL-1,(56.9±16.4)ng·mL-1,t=-3.391,P=0.001;(19.8±6.1)ng·mL-1,(16.0±4.5)ng·mL-1,t=-3.944,P=0.001;(780.6±336.1)pg·mL-1,(528.9±174.4)pg·mL-1,t=-4.489,P=0.001]。2组受试者血清25-羟基维生素D、甲状旁腺激素、降钙素含量比较,组间差异均无统计学意义[(20.7±10.3)ng·mL-1,(19.2±8.4)ng·mL-1,t=0.814,P=0.418;(39.1±18.0)pg·mL-1,(40.2±12.3)pg·mL-1,t=-1.175,P=0.240;(2.5±2.8)pg·mL-1,(2.9±2.4)pg·mL-1,t=-1.468,P=0.142]。②血液生化指标。血友病性关节炎组的血清钙含量低于健康体检组[(2.28±0.12)mmol·L-1,(2.33±0.11)mmol·L-1,t=-2.089,P=0.039],血清SCRP含量高于健康体检组[(7.99±12.85)mg·L-1,(3.42±4.51)mg·L-1,t=-2.232,P=0.026]。2组受试者血清磷含量、血清ALP含量、ESR比较,组间差异均无统计学意义[(1.21±0.19)mmol·L-1,(1.23±0.22)mmol·L-1,t=-0.631,P=0.529;(74.78±12.52)单位·L-1,(76.40±16.30)单位·L-1,t=-0.493,P=0.622;(5.13±6.77)mm·h-1,(5.47±13.87)mm·h-1,t=-1.660,P=0.097]。③骨密度T值。血友病性关节炎组的股骨颈骨密度T值低于健康体检组(-1.18±1.17,0.48±1.21,t=-5.814,P=0.001),2组受试者腰椎骨密度T值比较,差异无统计学意义(0.04±1.25,0.17±0.93,t=-1.577,P=0.115)。40例血友病性关节炎患者按照血友病的病情程度分为3组,其中轻度组10例、中度组16例、重度组14例。3组患者股骨颈骨密度T值比较,差异无统计学意义(-1.09±1.22,-0.87±1.31,-1.78±0.85,F=2.424,P=0.103)。3组患者腰椎骨密度T值总体比较,差异有统计学意义(0.01±1.23,0.41±1.44,-0.73±0.81,F=3.277,P=0.049); 进一步两两比较发现,中度组的腰椎骨密度T值大于重度组(P=0.015),轻度组的腰椎骨密度T值与中度组和重度组比较差异无统计学意义(P=0.700,P=0.138)。结论:血友病性关节炎可能继发骨质疏松症,但血友病病情程度与骨质疏松程度无明确关系。
Abstract:
Objective:To explore the relationship between hemophilic arthritis(HA)and osteoporosis(OP).Methods:The medical records of 40 HA male patients(HA group)and 60 healthy male volunteers(healthy group)recruited from December 2019 to December 2020 were analyzed retrospectively.The serum markers of bone metabolism including 25-hydroxy vitamin D(25(OH)D),parathyroid hormone(PTH),total N-terminal propeptide of typeⅠcollagen(TPⅠNP),osteocalcin(OCN),calcitonin,β-C-terminal telopeptide of typeⅠcollagen(β-CTX)and the blood biochemical indexes including calcium(Ca),phosphorus(P),alkaline phosphatase(ALP),supersensitive C-reaction protein(SCRP)and erythrocyte sedimentation rate(ESR)were compared between the 2 groups.The T values of bone mineral density(BMD)of left femoral neck(FN)and lumbar vertebra(LV)from L1 to L4 were compared between the 2 groups.According to the degree of HA,the 40 patients were divided into mild group(10 cases),moderate group(16 cases)and severe group(14 cases),and the T values of BMD of left FN and LV from L1 to L4 were compared between the 2 groups.Results:①The serum levels of TPⅠNP,OCN and β-CTX were higher in HA group compared to healthy group(76.8±31.1 vs 56.9±16.4 ng/mL,t=-3.391,P=0.001; 19.8±6.1 vs 16.0±4.5 ng/mL,t=-3.944,P=0.001; 780.6±336.1 vs 528.9±174.4 pg/mL,t=-4.489,P=0.001).There was no statistical difference in the serum levels of 25(OH)D,PTH and calcitonin between the 2 groups(20.7±10.3 vs 19.2±8.4 ng/mL,t=0.814,P=0.418; 39.1±18.0 vs 40.2±12.3 pg/mL,t=-1.175,P=0.240; 2.5±2.8 vs 2.9±2.4 pg/mL,t=-1.468,P=0.142).②The serum level of Ca was lower and the serum level of SCRP was higher in HA group compared to healthy group(2.28±0.12 vs 2.33±0.11 mmol/L,t=-2.089,P=0.039; 7.99±12.85 vs 3.42±4.51 mg/L,t=-2.232,P=0.026).There was no statistical difference in the ESR and the serum levels of P and ALP between the 2 groups(5.13±6.77 vs 5.47±13.87 mm/h,t=-1.660,P=0.097; 1.21±0.19 vs 1.23±0.22 mmol/L,t=-0.631,P=0.529; 74.78±12.52 vs 76.40±16.30 unit/L,t=-0.493,P=0.622).③The T value of BMD of FN was smaller in HA group compared to healthy group(-1.18±1.17 vs 0.48±1.21,t=-5.814,P=0.001).There was no statistical difference in the T value of BMD of LV from L1 to L4 between the 2 groups(0.04±1.25 vs 0.17±0.93,t=-1.577,P=0.115).There was no statistical difference in the T value of BMD of FN among mild group,moderate group and severe group(-1.09±1.22,-0.87±1.31,-1.78±0.85,F=2.424,P=0.103).There was statistical difference in the T value of BMD of LV from L1 to L4 among mild group,moderate group and severe group in general(0.01±1.23,0.41±1.44,-0.73±0.81,F=3.277,P=0.049).Further pairwise comparison showed that the T value of BMD of LV from L1 to L4 was larger in mild group compared to severe group,and there was no statistical difference between mild group and moderate group as well as between mild group and severe group(P=0.700,P=0.138).Conclusion:HA may cause secondary OP,but there is no clear relationship between the degree of HA and the degree of OP.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81873324)
通讯作者:童培建 E-mail:tongpeijian@163.com
更新日期/Last Update: 2022-02-20