[1]谭浩林,张润,王刚,等.绝经后骨质疏松症合并膝骨关节炎患者的骨代谢特征研究[J].中医正骨,2018,30(05):14-19.
　TAN Haolin,ZHANG Run,WANG Gang,et al.A clinical study of characteristics of bone metabolism in patients with postmenopausal osteoporosis and knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(05):14-19.
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绝经后骨质疏松症合并膝骨关节炎患者的骨代谢特征研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年05期
页码:
14-19
栏目:
临床研究
出版日期:
2018-05-20

文章信息/Info

Title:
A clinical study of characteristics of bone metabolism in patients with postmenopausal osteoporosis and knee osteoarthritis
作者:
谭浩林1; 张润2; 王刚1; 应航3; 4; 童培建3; 5
1.浙江省杭州市富阳中医骨伤医院,浙江 杭州 311400; 2.安徽中医药大学,安徽 合肥 230012; 3.浙江中医药大学,浙江 杭州 310053; 4.浙江省骨伤研究所,浙江 杭州 310053; 5.浙江省中医院,浙江 杭州 310006
Author(s):
TAN Haolin1; ZHANG Run2; WANG Gang1; YING Hang3; 4; TONG Peijian3; 5
1.Fuyang TCM Orthopedic-Traumatological Hospital,Hangzhou 311400,Zhejiang,China 2.Anhui Chinese Medical University,Hefei 230012,Anhui,China 3.Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang,China 4.Institute of Traumatology and Orthopedics of Zhejiang,Hangzhou 310053,Zhejiang,China 5.Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China
关键词:
骨关节炎; 膝;  骨质疏松; 绝经后;  骨密度;  骨代谢
Keywords:
osteoarthritis; knee;  osteoporosis; postmenopausal;  bone density;  bone metabolism
文献标志码:
A
摘要:
目的:探讨绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)合并膝骨关节炎(knee osteoarthritis,KOA)患者的骨代谢特征。方法:选择2014年11月至2017年3月在浙江省中医院就诊的PMOP合并KOA患者作为研究对象。拍摄患者站立位膝关节X线片,根据Kellgren和Lawrence影像分级标准将纳入研究的患者分为5组。采用双能X线吸收法测定患者L1～L4的骨密度,采用电化学发光免疫分析法测定患者的血清维生素D、甲状旁腺激素(parathyroid hormone,PTH)、Ⅰ型前胶原氨基端前肽(N-terminal propeptide of typeⅠprecollagen,PⅠNP)、N端中段骨钙素(N-terminal in the middle osteocalcin,N-MID-OT)、Ⅰ型胶原羧基端肽β特殊序列(β cross-linked C-telopeptide of typeⅠcollagen,β-CTX)水平。结果:纳入研究的患者共124例,0级组26例、Ⅰ级组15例、Ⅱ级组39例、Ⅲ级组26例、Ⅳ级组18例。5组患者的骨密度比较,差异有统计学意义[(0.800±0.045)g·cm-2,(0.788±0.048)g·cm-2,(0.813±0.042)g·cm-2,(0.827±0.051)g·cm-2,(0.849±0.049)g·cm-2,F=4.724,P=0.001]; 0级组的骨密度与Ⅰ级组、Ⅱ级组比较,组间差异均无统计学意义(P=0.436,P=0.291); 0级组的骨密度小于Ⅲ级组、Ⅳ级组(P=0.040,P=0.001); Ⅰ级组与Ⅱ级组的骨密度比较,差异无统计学意义(P=0.088); Ⅰ级组的骨密度小于Ⅲ级组、Ⅳ级组(P=0.012,P=0.000); Ⅱ级组与Ⅲ级组的骨密度比较,差异无统计学意义(P=0.228); Ⅱ级组的骨密度小于Ⅳ级组(P=0.007); Ⅲ级组与Ⅳ级组的骨密度比较,差异无统计学意义(P=0.126)。5组患者的血清维生素D、N-MID-OT含量比较,组间差异均无统计学意义[(16.72±9.66)ng·mL-1,(17.46±13.18)ng·mL-1,(17.92±13.22)ng·mL-1,(15.93±6.51)ng·mL-1,(16.23±5.54)ng·mL-1,F=0.180,P=0.948;(24.39±4.73)ng·mL-1,(25.92±5.45)ng·mL-1,(23.55±4.35)ng·mL-1,(22.44±4.71)ng·mL-1,(21.29±5.48)ng·mL-1,F=2.424,P=0.052]。5组患者血清PTH含量比较,差异有统计学意义[(40.59±7.74)pg·mL-1,(42.37±8.08)pg·mL-1,(44.37±9.44)pg·mL-1,(45.86±8.88)pg·mL-1,(48.18±8.69)pg·mL-1,F=2.457,P=0.049]; 0级组的血清PTH含量与Ⅰ级组、Ⅱ级组比较,组间差异均无统计学意义(P=0.529,P=0.089); 0级组的血清PTH含量低于Ⅲ级组、Ⅳ级组(P=0.031,P=0.005); Ⅰ级组的血清PTH含量与Ⅱ级组、Ⅲ级组、Ⅳ级组比较,组间差异均无统计学意义(P=0.452,P=0.220,P=0.059); Ⅱ级组的血清PTH含量与Ⅲ级组、Ⅳ级组比较,组间差异均无统计学意义(P=0.502,P=0.128); Ⅲ级组与Ⅳ级组的血清PTH含量比较,差异无统计学意义(P=0.388)。5组患者血清PINP含量比较,差异有统计学意义[(44.33±7.01)ng·mL-1,(45.55±6.55)ng·mL-1,(43.60±8.34)ng·mL-1,(39.25±6.31)ng·mL-1,(36.06±7.19)ng·mL-1,F=5.912,P=0.000]; 0级组的血清PINP含量与Ⅰ级组、Ⅱ级组比较,组间差异均无统计学意义(P=0.606,P=0.695); 0级组的血清PINP含量高于Ⅲ级组、Ⅳ级组(P=0.014,P=0.000); Ⅰ级组与Ⅱ级组的血清PINP含量比较,差异无统计学意义(P=0.381); Ⅰ级组的血清PINP含量高于Ⅲ级组、Ⅳ级组(P=0.009,P=0.000); Ⅱ级组的血清PINP含量高于Ⅲ级组和Ⅳ级组(P=0.020,P=0.000); Ⅲ级组与Ⅳ级组的血清PINP含量比较,差异无统计学意义(P=0.157)。5组患者血清β-CTX含量比较,差异有统计学意义[(874.93±189.91)pg·mL-1,(1 010.00±241.77)pg·mL-1,(810.64±104.43)pg·mL-1,(761.18±119.94)pg·mL-1,(728.25±193.47)pg·mL-1,F=8.178,P=0.000]; 0级组与Ⅱ级组的血清β-CTX含量比较,差异无统计学意义(P=0.120); 0级组的血清β-CTX含量高于Ⅲ级组、Ⅳ级组(P=0.013,P=0.004); Ⅰ级组的血清β-CTX含量高于0级组、Ⅱ级组、Ⅲ级组、Ⅳ级组(P=0.011,P=0.000,P=0.000,P=0.000); Ⅱ级组的血清β-CTX含量与Ⅲ级组、Ⅳ级组比较,组间差异均无统计学意义(P=0.231,P=0.077); Ⅲ级组与Ⅳ级组的血清β-CTX含量比较,差异无统计学意义(P=0.510)。结论:PMOP合并KOA患者,在KOA初期骨代谢呈以骨吸收为主的高转换状态,后期骨转换速率逐渐减慢,以骨形成为主。
Abstract:
Objective:To explore the characteristics of bone metabolism in patients with postmenopausal osteoporosis(PMOP)and knee osteoarthritis(KOA).Methods:The patients with PMOP and KOA who were treated in Zhejiang Provincial Hospital of Traditional Chinese Medicine from November 2014 to March 2017 were selected out as the subjects.The X-ray films of affected knee in standing position were taken,and the patients enrolled in the study were divided into 5 groups according to Kellgren-Lawrence imaging classification criteria.The bone densities of vertebrae from L2 to L4 were detected by using dual-energy X-ray absorptiometry(DEXA),and the serum levels of vitamin D,parathyroid hormone(PTH),N-terminal propeptide of typeⅠprecollagen(PⅠNP),N-terminal in the middle osteocalcin(N-MID-OT)and β cross-linked C-telopeptide of typeⅠcollagen(β-CTX)were measured by using electro-chemiluminescence immunoassay(ECLIA).Results:One hundred and twenty-four patients were enrolled in the study and were divided into grade 0 group(26),gradeⅠgroup(15),gradeⅡgroup(39),gradeⅢgroup(26)and gradeⅣgroup(18).There was statistical difference in the bone density between the 5 groups(0.800+/-0.045,0.788+/-0.048,0.813+/-0.042,0.827+/-0.051,0.849+/-0.049 g/cm(-2),F=4.724,P=0.001).There was no statistical difference in the bone density between grade 0 group and gradeⅠgroup and between grade 0 group and gradeⅡgroup(P=0.436,P=0.291).The bone density was lower in grade 0 group compared to gradeⅢgroup and gradeⅣgroup(P=0.040,P=0.001).There was no statistical difference in the bone density between gradeⅠgroup and gradeⅡgroup(P=0.088).The bone density was lower in gradeⅠgroup compared to gradeⅢgroup and gradeⅣgroup(P=0.012,P=0.000).There was no statistical difference in the bone density between gradeⅡgroup and gradeⅢgroup(P=0.228).The bone density was lower in gradeⅡgroup compared to gradeⅣgroup(P=0.007).There was no statistical difference in the bone density between gradeⅢgroup and gradeⅣgroup(P=0.126).There was no statistical difference in the serum contents of vitamin D and N-MID-OT between the 5 groups(16.72+/-9.66,17.46+/-13.18,17.92+/-13.22,15.93+/-6.51,16.23+/-5.54 ng/mL,F=0.180,P=0.948; 24.39+/-4.73,25.92+/-5.45,23.55+/-4.35,22.44+/-4.71,21.29+/-5.48 ng/mL,F=2.424,P=0.052).There was statistical difference in the serum contents of PTH between the 5 groups(40.59+/-7.74,42.37+/-8.08,44.37+/-9.44,45.86+/-8.88,48.18+/-8.69 pg/mL,F=2.457,P=0.049).There was no statistical difference in the serum contents of PTH between grade 0 group and gradeⅠgroup and between grade 0 group and gradeⅡgroup(P=0.529,P=0.089).The serum contents of PTH were lower in grade 0 group compared to gradeⅢgroup and gradeⅣgroup(P=0.031,P=0.005).There were no statistical difference in the serum contents of PTH between gradeⅠgroup and gradeⅡgroup,between gradeⅠgroup and gradeⅢgroup,between gradeⅠgroup and gradeⅣgroup,between gradeⅡgroup and gradeⅢgroup,between gradeⅡgroup and gradeⅣgroup and between gradeⅢgroup and gradeⅣgroup(P=0.452,P=0.220,P=0.059; P=0.502,P=0.128; P=0.388).There were statistical difference in the serum contents of PINP between the 5 groups(44.33+/-7.01,45.55+/-6.55,43.60+/-8.34,39.25+/-6.31,36.06+/-7.19 ng/mL,F=5.912,P=0.000).There was no statistical difference in the serum content of PINP between grade 0 group and grade Ⅰ group and between grade 0 group and grade Ⅱ group(P=0.606,P=0.695).The serum contents of PINP were higher in grade 0 group compared to gradeⅢgroup and gradeⅣgroup(P=0.014,P=0.000).There was no statistical difference in the serum contents of PINP between gradeⅠgroup and gradeⅡgroup(P=0.381).The serum contents of PINP were higher in gradeⅠgroup compared to gradeⅢgroup and gradeⅣgroup(P=0.009,P=0.000)and were higher in gradeⅡgroup compared to gradeⅢgroup and gradeⅣgroup(P=0.020,P=0.000).There was no statistical difference in the serum contents of PINP between gradeⅢgroup and gradeⅣgroup(P=0.157).There was statistical difference in the serum contents of β-CTX between the 5 groups(874.93+/-189.91,1 010.00+/-241.77,810.64+/-104.43,761.18+/-119.94,728.25+/-193.47 pg/mL,F=8.178,P=0.000).There was no statistical difference in the serum contents of β-CTX between grade 0 group and gradeⅡgroup(P=0.120).The serum contents of β-CTX were higher in grade 0 group compared to gradeⅢgroup and gradeⅣgroup(P=0.013,P=0.004),and were higher in gradeⅠgroup compared to grade 0 group,gradeⅡgroup,gradeⅢgroup and gradeⅣgroup(P=0.011,P=0.000,P=0.000,P=0.000).There was no statistical difference in the serum contents of β-CTX between gradeⅡgroup and gradeⅢgroup and between gradeⅡgroup and gradeⅣgroup(P=0.231,P=0.077).There was no statistical difference in the serum contents of β-CTX between gradeⅢgroup and gradeⅣgroup(P=0.510).Conclusion:The bone metabolism presents a state of high conversion characterized mainly by bone absorption in patients with PMOP and KOA in the early stage of KOA,and the bone turnover slows down gradually and presents mainly with bone formation in the later stage of KOA.

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更新日期/Last Update: 1900-01-01