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目的探讨乙型肝炎肝硬化患者骨代谢异常的发病机制。方法用NM-300单光子骨密度测量系统检测61例乙型肝炎肝硬化患者的骨密度,空腹抽血检测血清钙调节激素:1,25二羟维生素D3[1,25 (OH)2D3]、甲状旁腺素(PTH)、降钙素(CT)、骨钙素(BGP),白细胞介素-1β(IL-1β)、白细胞介素- 6(IL-6),肿瘤坏死因子a(TNF a)、尿骨胶原交联(Crosslaps),并与30名健康者对照。结果肝硬化组尺骨密度、桡骨密度、尺桡密度均较对照组明显降低。肝硬化组血清1,25(OH)2D3、BGP水平较对照组明显降低,其中骨质疏松(OP)组较无骨质疏松(NOP)组降低更明显,尿Crosslaps水平肝硬化组较对照组明显升高,其中OP组较NOP升高更明显。血清1,25(OH)2D3、BGP水平与尺桡密度呈正相关。OP组尿 Crosslaps水平与尺桡密度呈负相关,而NOP组尿Crosslaps水平与尺桡密度无相关关系。肝硬化组血清IL- 1β、IL-6、TNF α水平较对照组明显升高。血清IL—1β、IL-6、TNF α水平肝硬化OP组较NOP组显著升高。肝硬化组IL—1β、IL-6、TNF α水平与尺桡密度呈负相关,其中OP组较NOP组相关性更明显。结论乙型肝炎肝硬化患者存在着骨形成减少和骨破坏过多两种因素,从而引起肝性骨病,在骨形成减弱的过程中1．25(OH)2D3起了主要作用,在骨吸收增强的过程中IL一1β、IL-6、TNF α起到了重要的作用。
Objective To investigate the pathogenesis of abnormal bone metabolism in patients with hepatitis B cirrhosis. Methods The bone mineral density (BMD) of 61 patients with cirrhosis of liver cirrhosis was detected by NM-300 single-photon bone density measurement system. Serum calcium-regulated hormones: 1,25-dihydroxyvitamin D3 [1,25 (OH) 2D3] PTH, CT, BGP, IL-1β, IL-6, TNF a), Crosslaps, and 30 healthy controls. Results The ulnar, radial and ulnar radial densities of cirrhosis group were significantly lower than those of the control group. The levels of serum 1,25 (OH) 2D3 and BGP in cirrhosis group were significantly lower than those in control group, especially in osteoporosis (OP) group than those without osteoporosis (NOP) group. Compared with control group Significantly higher, including OP group increased more significantly than NOP. Serum 1,25 (OH) 2D3, BGP level and ulnar radial density was positively correlated. There was a negative correlation between the level of urine Crosslaps and the ulnar radial density in OP group, while there was no correlation between the level of urine Crosslaps and the ulnar radial density in NOP group. The levels of serum IL-1β, IL-6 and TNFα in cirrhosis group were significantly higher than those in control group. Serum levels of IL-1β, IL-6 and TNFα in cirrhosis OP group were significantly higher than those in NOP group. The levels of IL-1β, IL-6 and TNFα in cirrhotic patients were negatively correlated with ulnar radial densities. The correlation between OP and NOP was more obvious. Conclusions Hepatitis B cirrhosis patients with hepatitis B cirrhosis have decreased bone formation and excessive destruction of bone. 1.25 (OH) 2D3 plays a major role in the process of reduced bone formation. In bone resorption IL-1β, IL-6 and TNFα play an important role in the process of enhancement.