非酒精性脂肪性肝病与血清维生素D及骨密度的关系

曲玉蕾; 王迎春; 万金鑫

doi:10.3969/j.issn.1001-5256.2019.09.027

非酒精性脂肪性肝病与血清维生素D及骨密度的关系

DOI: 10.3969/j.issn.1001-5256.2019.09.027

1. 大连大学附属中山医院消化二科
2. 大连大学

基金项目:

大连大学博士启动专项基金资助(20181QL005)；

详细信息

中图分类号: R575.5
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出版历程
- 收稿日期: 2019-04-16
- 出版日期: 2019-09-20

Association of nonalcoholic fatty liver disease with vitamin D and bone mineral density

Second Department of Gastroenterology, Zhongshan Hospital Affiliated to Dalian University

Research funding:

摘要

摘要:
目的探讨非酒精性脂肪性肝病（NAFLD）与维生素D及骨密度的关系。方法选取2018年5月-2019年3月于大连大学附属中山医院住院及门诊就诊的NAFLD患者180例为NAFLD组,另选取年龄及性别相匹配的健康体检者180例为对照组。比较2组维生素D、骨密度、骨代谢生化标志物[β胶原降解产物（β-CTX）、Ⅰ型胶原氨基端延长肽（P1NP）、骨钙素（OC）]的差异。正态分布的计量资料2组间比较采用独立样本t检验,非正态分布采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验。相关性采用Spearman秩相关分析;采用二项分类logistic回归分析NAFLD的相关危险因素。结果 NAFLD组25（OH） D[13. 06（10. 73～19. 77） ng/ml vs 19. 88（12. 56～22. 60） ng/ml,Z=-1. 37,P=0. 041]、L1-4骨密度[0. 87（0. 83～1. 05） g/cm2vs1. 05（0. 92～1. 21） g/cm2,Z=-2. 17,P=0. 034]、股骨颈骨密度[（0. 76±0. 21） g/cm2vs（0...
- 非酒精性脂肪性肝病 /
- 维生素D /
- 骨密度 /
- 骨质疏松 /
- 危险因素
Abstract:
Objective To investigate the association of nonalcoholic fatty liver disease ( NAFLD) with vitamin D and bone mineral density.Methods A total of 180 patients with NAFLD who were hospitalized or visited the outpatient service of Zhongshan Hospital Affiliated to Dalian University from May 2018 to March 2019 were enrolled as NAFLD group, and 180 healthy individuals matched for age and sex who underwent physical examination were enrolled as control group. The two groups were compared in terms of vitamin D, bone mineral density, and biochemical markers for bone metabolism [β isomer of C-terminal telopeptide of type I collagen ( β-CTX) , type 1 procollagen amino terminal peptide ( P1 NP) , and osteocalcin ( OC) ]. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data. The chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was performed, and a binary logistic regression analysis was used to investigate the risk factors for NAFLD. Results Compared with the control group, the NAFLD group had significantly lower levels of 25 ( OH) D [13. 06 ( 10. 73-19. 77) ng/ml vs 19. 88 ( 12. 56-22. 60) ng/ml, Z =-1. 37, P = 0. 041], L1-4 bone mineral density[0. 87 ( 0. 83-1. 05) g/cm2 vs 1. 05 ( 0. 92-1. 21) g/cm2, Z =-2. 17, P = 0. 034], bone mineral density of the femoral neck ( 0. 76 ±0. 21 g/cm2 vs 0. 84 ± 0. 51 g/cm2, t = 2. 02, P = 0. 015) , P1 NP [45. 40 ( 33. 35-58. 02) ng/ml vs 67. 39 ( 48. 09-87. 49) ng/ml, Z =-0. 83, P = 0. 044], and OC [14. 79 ( 11. 64-18. 87) ng/ml vs 17. 29 ( 15. 16-21. 04) ng/ml, Z =-2. 09, P = 0. 037], as wellas a significantly higher level of β-CTX [354. 75 ( 186. 32-526. 57) pg/ml vs 287. 67 ( 164. 10-497. 76) pg/ml, Z =-1. 04, P =0. 027]. Compared with those with alanine aminotransferase ( ALT) ≤2 × upper limit of normal ( ULN) , the NAFLD patients with ALT >2 × ULN had significantly lower levels of 25 ( OH) D ( 13. 51 ± 3. 20 ng/ml vs 18. 86 ± 3. 70 ng/ml, t = 3. 02, P = 0. 038) , L1-4 bone mineral density ( 0. 75 ± 0. 24 g/cm2 vs 1. 05 ± 0. 31 g/cm2, t = 2. 17, P = 0. 035) , and bone mineral density of the femoral neck ( 0. 71 ± 0. 18 g/cm2 vs 0. 82 ± 0. 21 g/cm2, t = 2. 25, P = 0. 042) . There were no significant differences in 25 ( OH) D, L1-4 bone mineral density, and bone mineral density of the femoral neck between the groups of patients with different degrees of fatty liver disease on CT ( all P > 0. 05) .Bone mineral density was positively correlated with high-density lipoprotein cholesterol ( r = 0. 232, P < 0. 05) and was negatively correlated with body mass index ( BMI) ( r =-0. 271, P < 0. 05) , blood glucose ( Glu) ( r =-0. 242, P < 0. 05) , ALT ( r =-0. 375, P < 0. 05) , aspartate aminotransferase ( r =-0. 312, P < 0. 05) , and low-density lipoprotein cholesterol ( r =-0. 247, P < 0. 05) . The logistic regression analysis showed that 25 ( OH) D ( odds ratio [OR] = 1. 113, 95% confidence interval [CI]: 1. 023-1. 210, P =0. 013) , BMI ( OR = 0. 676, 95% CI: 0. 522-0. 877, P = 0. 003) , and Glu ( OR = 0. 350, 95% CI: 0. 139-0. 882, P = 0. 026) were influencing factors for NAFLD. Conclusion Patients with NAFLD have significantly lower levels of vitamin D and bone mineral density than healthy individuals. An analysis of serum vitamin D and bone mineral density can further clarify the features of bone metabolism in NAFLD, and early screening of NAFLD with osteoporosis should be performed to improve the prognosis and quality of life of patients with NAFLD.
- non-alcoholic fatty liver disease /
- vitamin D /
- bone density /
- osteoporosis /
- risk factors

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参考文献(19)

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