摘要
目的探讨核苷(酸)类治疗的慢性乙型肝炎(CHB)患者骨质减少/骨质疏松症发生的风险及危险因素。方法随机选取山东省公共卫生临床中心2019年1月—2021年6月就诊的应用核苷(酸)类抗病毒治疗的CHB患者1000例,其中男600例,女400例,测量非受力侧前臂尺桡骨中远端1/3处骨密度T值和Z值,依据WHO诊断标准分为骨质正常组、骨质减少组和骨质疏松组。分析这三组患者的性别、年龄、病程、抗病毒治疗药物、体质指数(BMI)、凝血功能、血钙、血磷、碱性磷酸酶(ALP)、纤维化水平的差异,分析骨密度下降的危险因素。结果应用核苷(酸)治疗的CHB患者中,骨密度减少的患者比例为24.6%,骨质疏松患者的比例为18.2%。单因素分析提示年龄增大、女性、低BMI、应用阿德福韦酯或替诺福韦、血肌酐水平增高的患者发生骨密度下降的风险增加,多因素logistic回归分析结果提示,年龄(OR值1.06,95%可信区间1.02~1.11,P=0.005)、女性(OR值1.37,95%可信区间1.56~2.13,P=0.015)、低BMI(OR值0.88,95%可信区间0.81~0.97,P=0.015)、肌酐水平(OR值2.00,95%可信区间1.97~2.03,P=0.025)及服用阿德福韦酯或替诺福韦酯(OR值2.95,95%可信区间1.14~7.45,P=0.028)与骨密度减少具有相关性。应用阿德福韦或者替诺福韦抗病毒治疗的患者,其血磷水平更低。结论核苷(酸)经治的CHB患者更易发生骨质减少和骨质疏松,其中年龄增大、女性、低BMI、肌酐水平升高及服用阿德福韦酯或替诺福韦酯抗病毒治疗增加了CHB患者发生骨质减少和骨质疏松的风险。应用阿德福韦或者替诺福韦抗病毒治疗的患者更易导致血磷下降。
Objective To investigate the incidence and risk factors of osteoporosis(OP)in chronic hepatitis B(CHB)patients treated with nucleos(t)ide analogues(NAs).Methods A total of 1000 cases(male 600 cases,female 400 cases)of CHB patients admitted to our hospital from January 2019 to June 2021 were divided into 3 groups according to the diagnostic criteria of based on the measurement T and Z values of bone density in the middle and distal 1/3 of the ulnar radius of the non-stressed side of the forearm:normal bone group,osteopenia group and osteoporosis group.The general data and related factors of OP were recorded.The risk factors of OP were analyzed with multivariate logistic regression analysis.Results Among the 1000 CHB patients,36.8%had osteopenia,and 18.2%had OP.The results of multivariate logistic regression analysis showed that age(OR=1.06,95%CI:1.02-1.11,P=0.005),female(OR=1.37,95%CI:1.56-2.13,P=0.015),low body mass index(BMI)(OR=0.88,95%CI:0.81-0.97,P=0.015),creatinine level(OR=1.45,95%CI:1.97-2.03,P=0.025)and taking adefovir dipivoxil or tenofovir dipivoxil(OR=1.00,95%CI:1.14-7.45,P=0.028)were correlated with bone mineral density.The blood phosphorus levels of patients treated with adefovir or tenofovir were lower.Conclusion CHB patients treated with NAs are more likely to have osteopenia and OP.The risk of osteopenia and OP is positive correlated with age,gender,low BMI,elevated creatinine level and taking adefovir dipivoxil or tenofovir dipivoxil antiviral therapy.Early prevention and detection should be done to reduce or delay the occurrence of OP.
作者
解双双
程文瑾
焦军霞
刘晓艳
刘莉
XIE Shuang-shuang;CHENG Wen-jin;JIAO Jun-xia;LIU Xiao-yan;LIU Li(Department of Gastroenterology I,Shan Dong Public Health Clinical Center,Jinan 250102,China;Shan Dong University Qilu Medical College,Jinan 250012,China)
出处
《肝脏》
2023年第3期309-312,329,共5页
Chinese Hepatology
基金
济南市卫健委科技项目(2019-2-35)。
