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[1]譚浩林,張潤(rùn),王剛,等.絕經(jīng)后骨質(zhì)疏松癥合并膝骨關(guān)節(jié)炎患者的骨代謝特征研究[J].中醫(yī)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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絕經(jīng)后骨質(zhì)疏松癥合并膝骨關(guān)節(jié)炎患者的骨代謝特征研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年05期
頁(yè)碼:
14-19
欄目:
臨床研究
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:
譚浩林1; 張潤(rùn)2; 王剛1; 應(yīng)航3; 4; 童培建3; 5
1.浙江省杭州市富陽(yáng)中醫(yī)骨傷醫(yī)院,浙江 杭州 311400; 2.安徽中醫(yī)藥大學(xué),安徽 合肥 230012; 3.浙江中醫(yī)藥大學(xué),浙江 杭州 310053; 4.浙江省骨傷研究所,浙江 杭州 310053; 5.浙江省中醫(yī)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
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  骨質(zhì)疏松; 絕經(jīng)后;  骨密度;  骨代謝
Keywords:
osteoarthritis; knee;  osteoporosis; postmenopausal;  bone density;  bone metabolism
文獻(xiàn)標(biāo)志碼:
A
摘要:
目的:探討絕經(jīng)后骨質(zhì)疏松癥(postmenopausal osteoporosis,PMOP)合并膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)患者的骨代謝特征。方法:選擇2014年11月至2017年3月在浙江省中醫(yī)院就診的PMOP合并KOA患者作為研究對(duì)象。拍攝患者站立位膝關(guān)節(jié)X線片,根據(jù)Kellgren和Lawrence影像分級(jí)標(biāo)準(zhǔn)將納入研究的患者分為5組。采用雙能X線吸收法測(cè)定患者L1～L4的骨密度,采用電化學(xué)發(fā)光免疫分析法測(cè)定患者的血清維生素D、甲狀旁腺激素(parathyroid hormone,PTH)、Ⅰ型前膠原氨基端前肽(N-terminal propeptide of typeⅠprecollagen,PⅠNP)、N端中段骨鈣素(N-terminal in the middle osteocalcin,N-MID-OT)、Ⅰ型膠原羧基端肽β特殊序列(β cross-linked C-telopeptide of typeⅠcollagen,β-CTX)水平。結(jié)果:納入研究的患者共124例,0級(jí)組26例、Ⅰ級(jí)組15例、Ⅱ級(jí)組39例、Ⅲ級(jí)組26例、Ⅳ級(jí)組18例。5組患者的骨密度比較,差異有統(tǒng)計(jì)學(xué)意義[(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級(jí)組的骨密度與Ⅰ級(jí)組、Ⅱ級(jí)組比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.436,P=0.291); 0級(jí)組的骨密度小于Ⅲ級(jí)組、Ⅳ級(jí)組(P=0.040,P=0.001); Ⅰ級(jí)組與Ⅱ級(jí)組的骨密度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.088); Ⅰ級(jí)組的骨密度小于Ⅲ級(jí)組、Ⅳ級(jí)組(P=0.012,P=0.000); Ⅱ級(jí)組與Ⅲ級(jí)組的骨密度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.228); Ⅱ級(jí)組的骨密度小于Ⅳ級(jí)組(P=0.007); Ⅲ級(jí)組與Ⅳ級(jí)組的骨密度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.126)。5組患者的血清維生素D、N-MID-OT含量比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(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組患者血清PTH含量比較,差異有統(tǒng)計(jì)學(xué)意義[(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級(jí)組的血清PTH含量與Ⅰ級(jí)組、Ⅱ級(jí)組比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.529,P=0.089); 0級(jí)組的血清PTH含量低于Ⅲ級(jí)組、Ⅳ級(jí)組(P=0.031,P=0.005); Ⅰ級(jí)組的血清PTH含量與Ⅱ級(jí)組、Ⅲ級(jí)組、Ⅳ級(jí)組比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.452,P=0.220,P=0.059); Ⅱ級(jí)組的血清PTH含量與Ⅲ級(jí)組、Ⅳ級(jí)組比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.502,P=0.128); Ⅲ級(jí)組與Ⅳ級(jí)組的血清PTH含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.388)。5組患者血清PINP含量比較,差異有統(tǒng)計(jì)學(xué)意義[(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級(jí)組的血清PINP含量與Ⅰ級(jí)組、Ⅱ級(jí)組比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.606,P=0.695); 0級(jí)組的血清PINP含量高于Ⅲ級(jí)組、Ⅳ級(jí)組(P=0.014,P=0.000); Ⅰ級(jí)組與Ⅱ級(jí)組的血清PINP含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.381); Ⅰ級(jí)組的血清PINP含量高于Ⅲ級(jí)組、Ⅳ級(jí)組(P=0.009,P=0.000); Ⅱ級(jí)組的血清PINP含量高于Ⅲ級(jí)組和Ⅳ級(jí)組(P=0.020,P=0.000); Ⅲ級(jí)組與Ⅳ級(jí)組的血清PINP含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.157)。5組患者血清β-CTX含量比較,差異有統(tǒng)計(jì)學(xué)意義[(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級(jí)組與Ⅱ級(jí)組的血清β-CTX含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.120); 0級(jí)組的血清β-CTX含量高于Ⅲ級(jí)組、Ⅳ級(jí)組(P=0.013,P=0.004); Ⅰ級(jí)組的血清β-CTX含量高于0級(jí)組、Ⅱ級(jí)組、Ⅲ級(jí)組、Ⅳ級(jí)組(P=0.011,P=0.000,P=0.000,P=0.000); Ⅱ級(jí)組的血清β-CTX含量與Ⅲ級(jí)組、Ⅳ級(jí)組比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.231,P=0.077); Ⅲ級(jí)組與Ⅳ級(jí)組的血清β-CTX含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.510)。結(jié)論:PMOP合并KOA患者,在KOA初期骨代謝呈以骨吸收為主的高轉(zhuǎn)換狀態(tài),后期骨轉(zhuǎn)換速率逐漸減慢,以骨形成為主。
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