脊髓损伤康复患者骨密度及骨代谢标记物特点的分析

doi:10.3969/j.issn.1006-9771.2021.04.007

摘要/Abstract

摘要： 目的

分析脊髓损伤康复患者的骨密度和骨代谢标记物特点及其相关因素。

方法

选取2018年4月至2020年5月于本院住院的脊髓损伤康复患者78例，根据不同损伤病程分组。选取同期健康体检人员作为对照。应用双能X线吸收法测量股骨近端骨密度，检测脊髓损伤患者的骨代谢标记物。骨密度与临床指标进行相关性分析。

结果

脊髓损伤3个月内，患者股骨近端骨密度与对照组无显著性差异(P > 0.05)；损伤3~6个月，大转子、转子间、全髋骨密度低于对照组(|t| > 2.242, P < 0.05)；损伤6~12个月，股骨颈、大转子、转子间、全髋骨密度低于对照组(|t| > 2.026, P < 0.05)；损伤12~24个月，股骨近端骨密度均低于对照组(|t| > 2.189, P < 0.05)。骨密度降幅随损伤病程延长而更加明显。截瘫与四肢瘫、完全性与不完全性损伤患者间的骨密度无显著性差异(P > 0.05)。羧基端肽(CTX)和I型前胶原N端前肽(PINP)于各损伤病程均高于参考范围上限，损伤3个月内即升高，3~6个月达高峰，7个月后降至稳态。脊髓损伤患者维生素D缺乏者占87.5%。股骨颈和全髋骨密度均与损伤病程呈负相关(|r| > 0.250, P < 0.05)，与体质量指数呈正相关(r > 0.255, P < 0.05)。

结论

股骨近端骨密度随脊髓损伤病程增加而降低。脊髓损伤早期骨代谢呈高转换型。脊髓损伤患者维生素D缺乏率相当高。有必要在脊髓损伤早期阶段进行骨代谢标记物结合骨密度的测定来评估患者的骨健康状况。

关键词: 脊髓损伤, 废用性骨质疏松, 骨密度, 骨代谢

Abstract: Objective

To analyze the changes of bone mineral density (BMD), the characteristics of bone metabolic markers and related factors in patients with spinal cord injury (SCI).

Methods

A total of 78 patients with SCI in our hospital from April, 2018 to May, 2020 were selected and divided into groups according to the injury courses. The people receiving physical examination in the same period were selected as control. BMD of proximal femur was measured by dual energy X-ray absorptiometry. Bone metabolic markers were detected. The correlation between BMD and clinical indicators was analyzed.

Results

There was no difference in BMD between the patients within three months and the controls (P > 0.05). BMD at trochanter major, intertrochanteric and total hip in patients three to six months post injury was lower than that in the controls (|t| > 2.242, P < 0.05). The BMD at femoral neck, trochanter major, intertrochanteric and total hip in patients during six to twelve months post injury was lower than that in the controls (|t| > 2.026, P < 0.05). BMD at proximal femur in patients with twelve to 24 months post injury was lower than that in the controls (|t| > 2.189, P < 0.05). The decrease of BMD aggravated with the course of injury. There was no difference in BMD between paraplegia and quadriplegia, complete injury and incomplete injury (P > 0.05). Collagen type I C-terminal telopeptide (CTX) and N-terminal propeptide of type l precollagen (PINP) were higher than the reference range in the course of each injury, increased within three months post injury, reached the peak at three to six months post injury, and decreased to a steady state since seven months post injury. Vitamin D deficiency occurred in 87.5% of the patients. BMD at femoral neck and total hip was negatively correlated with the course of injury (|r| > 0.250, P < 0.05), and positively correlated with body mass index (r > 0.255, P < 0.05).

Conclusion

The longer the duration of SCI, the more decrease of BMD. The early bone metabolism of patients with SCI is high conversion type. The rate of vitamin D deficiency in patients with SCI is quite high. It is necessary to detect and evaluate the bone metabolic markers combined with BMD at the early stage of SCI.

Key words: spinal cord injury, disuse osteoporosis, bone mineral density, bone metabolism

中图分类号:

R651.2

郑欣,戚艳艳,周红俊,康海琼,佟艳铭. 脊髓损伤康复患者骨密度及骨代谢标记物特点的分析[J]. 《中国康复理论与实践》, 2021, 27(4): 429-435.

Xin ZHENG,Yan-yan QI,Hong-jun ZHOU,Hai-qiong KANG,Yan-ming TONG. Bone Mineral Density and Bone Metabolic Markers for Patients with Spinal Cord Injury in Rehabilitation Wards[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(4): 429-435.

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组别	n	性别(男/女，n)	年龄(岁)	BMI (kg/m²)
对照组	52	39/13	37.87±10.62	23.38±2.94
脊髓损伤组	78	60/18	37.42±10.99	23.11±3.60
t/χ²值		0.064	-0.136	-0.229
P值		0.801	0.892	0.820

项目	数值
例数(n)	78
性别(男/女，n)	60/18
年龄(岁)	37.42±10.99
损伤病程(月)	2.8(1.2, 8.0)
病因(创伤/非创伤，n)	66/12
瘫痪类型(截瘫/四肢瘫，n)	60/18
损伤程度(完全性/不完全性，n)	43/35
BMI (kg/m²)	23.11±3.60
股骨颈骨密度(g/cm²)	0.757±0.121
股骨颈Z值全髋骨密度(g/cm²)	-0.828±0.867 0.907±0.137
全髋Z值	-0.571±0.955
Ca (mmol/L)	2.34±0.12
P (mmol/L)	1.40±0.20
ALP (IU/L)	72.90 (61.00, 101.60)
25-OHD (ng/ml)	13.96±5.45
CTX (ng/ml)	1.01±0.40
PINP (ng/ml)	102.00 (71.73, 145.75)
OC (ng/ml)	19.81±7.43
PTH (ng/ml)	22.15 (17.47, 27.47)

组别	n	股骨颈	大转子	转子间	Ward's	全髋
对照组	39	0.832±0.139	0.686±0.092	1.213±0.154	0.685±0.135	1.018±0.128
脊髓损伤组	39	0.777±0.126	0.643±0.095	1.116±0.191	0.636±0.157	0.954±0.131
降幅		6.61%	6.27%	7.99%	7.15%	6.29%
t值		-1.536	-1.647	-1.984	-1.179	-1.768
P值		0.131	0.106	0.053	0.244	0.083

组别	n	股骨颈	大转子	转子间	Ward's	全髋
对照组	13	0.836±0.146	0.686±0.095	1.232±0.142	0.670±0.144	1.044±0.128
脊髓损伤组	13	0.755±0.142	0.615±0.076	1.043±0.165	0.649±0.192	0.897±0.192
降幅		9.69%	10.35%	15.35%	3.13%	14.08%
t值		-1.597	-2.242	-3.624	-0.385	-3.272
P值		0.118	0.031	0.001	0.702	0.002

组别	n	股骨颈	大转子	转子间	Ward's	全髋
对照组	15	0.839±0.146	0.691±0.096	1.213±0.161	0.703±0.124	1.032±0.138
脊髓损伤组	15	0.744±0.115	0.574±0.130	1.048±0.147	0.675±0.161	0.881±0.133
降幅		11.32%	16.93%	16.50%	3.98%	14.63%
t值		-2.026	-3.229	-3.087	-0.607	-3.241
P值		0.049	0.002	0.004	0.547	0.002