摘要
目的评价多发性硬化(MS)患者与年龄-性别配比均衡健康者的骨密度(BMD)水平差异,以明确MS患者功能缺损与激素冲击治疗对骨质流失的影响。方法收集2008—2010年我院MS患者65人为病例组,年龄-性别配比均衡的健康对照组328人。利用Kurtzke的EDSS评分系统评价病例组残疾状况。采用双能X线骨密度仪测量腰椎、股骨颈、全髋部BMD。检测血清钙、磷、25-羟维生素D〔25-(OH)D〕。结果 MS患者在规律补充维生素D 200 U/d的前提下血25-(OH)D仍低于对照组,差异有统计学意义(P<0.05)。病例组腰椎、股骨颈以及全髋部BMD水平低于对照组,差异均有统计学意义(P<0.05)。腰椎BMD(r=-0.45,P=0.038)、股骨颈BMD(r=-0.16,P=0.017)与MS病程呈负相关。25-(OH)D水平同腰椎BMD存在正相关(r=0.29,P=0.025)。EDSS评分与BMD水平呈负相关(r腰椎=-0.17,P=0.012;r股骨颈=-0.24,P=0.001;r全髋部=-0.31,P=0.015)。类固醇激素累计使用剂量仅与股骨颈BMD呈负相关(r=-0.30,P=0.005)。结论 MS患者BMD水平明显减低,运动能力下降及糖皮质激素的应用都会导致BMD水平下降,因此MS患者在康复过程中应注意加强锻炼,并采取一定的措施预防骨质流失。
Objective To evaluate bone mineral mass in patients with multiple sclerosis （ MS）, and the association of glucocorticoid use and ambulation ability with the changes of bone mass. Methods Sixty five patients with MS and 328 age - and sex - matched healthy controls participated in this study in our hospital from 2008 to 2010. The Kurtzke expanded disability status scale （EDSS） was used to evaluate disability and functional capacity. Bone mineral density （BMD） of lumbar spine, femoral neck, and total femur was measured using dual - energy X - ray absorptiometry. Serum calcium, phosphorus, and 25 - hydroxy vitamin D [25 - （OH） D] levels were assessed. Results The 25 - （OH） D level in MS patients was significantly lower than that of the controls （ P 〈 0. 05 ）, even after the patients were given vitamin D 200 U/d. The MS patients had significantly lower BMD of the lumbar spine, femoral neck and total femur than the controls （ P 〈 0.05 ） . The lumbar spine BMD and femoral neck BMDwere negatively correlated with MS disease duration （r = - 0.45, P = 0.038; r = -0.16, P = 0.017） .The 25 - （OH） D level was positively correlated with lumbar spine BMD （ r = 0. 29, P =0. 025 ） . EDSS scores were negatively cor- related with BMD （ r lumbar apine= -0. 17, P = 0. 012 ; r femoral neck=- 0. 24, P = 0. 001 ; r total femur = - 0. 31, P = 0. 015 ） . There was a negative correlation between cumulative steroid dose and femoral neck BMD （ r = -0. 30, P = 0. 005 ） . Conclusion BMD was significantly lower in MS patients. Glucocorticoid usage and decreased ambulatory status were associated with low BMD in MS patients. These patients should be encouraged to do more proper exercise and take other protective measures to maintain their bone mass.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第28期3329-3331,共3页
Chinese General Practice
关键词
多发性硬化
骨密度
骨质疏松
类固醇激素
Multiple sclerosis
Bone mineral density
Osteoporosis
Steroid
