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目的探讨慢性阻塞性肺疾病(COPD)患者肺功能与骨密度、血清抗酒石酸酸性磷酸酶5b(TRACP-5b)水平及骨质疏松症的关系。方法 60岁以上男性COPD患者48例,根据一秒用力呼气容积(FEV1)分为两组:FEV1<80%为COPD中重度组28例(A组);FEV1>80%为COPD轻度组20例(B组);选择同期男性健康体检者40例作为对照(C组)。用双能X线吸收测定仪(DEXA)测定3组腰椎、股骨颈部骨密度(BMD),同时测定肺功能以及血清TRACP-5b水平,比较不同肺功能组患者骨密度、TRACP-5b的关系。结果 A组骨密度较B、C组降低(P<0.01);A组股骨颈及腰椎骨质疏松发生率高于B、C组(53.6%vs.25.0%、12.5%,60.7%vs.30.0%、20.0%)(P<0.05)。A组TRACP-5b值为(4.2±1.7)U/L,高于B和C组的(3.3±0.6)U/L和(2.5±0.8)U/L(P<0.05)。相关性分析显示,BMD与FEV1呈直线正相关(P<0.01)。TRACP-5b水平与FEV1水平及股骨颈、腰椎BMD呈负相关(P<0.01)。结论 60岁以上COPD患者骨密度降低;骨密度值与肺功能、体重指数(BMI)呈正相关,与血清TRACP-5b水平呈负相关。检测血清TRACP-5b对60岁以上COPD患者合并骨质疏松症的诊断有一定价值。
Objective To investigate the relationship between lung function and bone mineral density (BMD), serum level of tartrate-resistant acid phosphatase 5b (TRACP-5b) and osteoporosis in patients with chronic obstructive pulmonary disease (COPD). Methods Forty-eight male patients with COPD over the age of 60 were divided into two groups based on FEV1: FEV1 <80% for COPD moderate-severe group 28 cases (group A); FEV1> 80% for mild COPD group Twenty cases (group B), and 40 healthy male subjects were selected as control group (group C). The bone mineral density (BMD) in the lumbar and femoral neck was measured by dual energy X-ray absorptiometry (DEXA). The lung function and TRACP-5b levels were also measured. The bone mineral density and TRACP-5b in different lung function groups were compared . Results The BMD of group A was lower than that of group B and C (P <0.01). The incidence of osteoporosis of femoral neck and lumbar in group A was higher than that of group B and C (53.6% vs.25.0%, 12.5%, 60.7% vs.30.0 %, 20.0%) (P <0.05). The TRACP-5b in group A was (4.2 ± 1.7) U / L, higher than that in group B and C (3.3 ± 0.6) U / L and (2.5 ± 0.8) U / L, respectively (P <0.05). Correlation analysis showed that there was a linear positive correlation between BMD and FEV1 (P <0.01). TRACP-5b levels were negatively correlated with FEV1 level and femoral neck and lumbar BMD (P <0.01). Conclusions BMD in COPD patients over the age of 60 was decreased. BMD was positively correlated with pulmonary function and body mass index (BMI), but negatively correlated with serum TRACP-5b level. Detection of serum TRACP-5b for COPD patients over 60 years of age with the diagnosis of osteoporosis has some value.