首 页   本刊简介  编委会  审稿专家  在线期刊  写作规范  广告合作  联系我们
您现在的位置:首页 => 在线期刊 => 2019年 9期肝衰竭诊治的临床与基础研究 => 其他 =>非酒精性脂肪性肝病与..
非酒精性脂肪性肝病与血清维生素D及骨密度的关系
Association of nonalcoholic fatty liver disease with vitamin D and bone mineral density
文章发布日期:2019年08月19日  来源:  作者:曲玉蕾,王迎春,万金鑫  点击次数:109次  下载次数:16次

调整字体大小:

(此处下载失败可以在在线预览处保存副本或者右键另存为)

【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/cm2 vs 105(0.92~1.21)g/cm2,Z=-2.17,P=0.034]、股骨颈骨密度[(0.76±0.21)g/cm2 vs(0.84±0.51)g/cm2,t=2.02,P=0.015]、P1NP[4540(33.35~58.02)ng/ml vs 67.39(48.09~87.49)ng/ml,Z=-0.83,P=0.044]和OC[14.79(11.64~18.87)ng/ml vs 1729(1516~21.04)ng/ml,Z=-209,P=0.037]水平均明显低于对照组;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]水平明显高于对照组。NAFLD患者25(OH)D[(13.51±3.20)ng/ml vs(18.86±3.70)ng/ml,t=3.02,P=0.038]及L1-4骨密度[(0.75±0.24)g/cm2 vs(1.05±0.31)g/cm2,t=2.17,P=0.035]、股骨颈骨密度[(0.71±0.18)g/cm2 vs(0.82±0.21)g/cm2,t=2.25,P=0.042]在ALT>2倍正常值上限(ULN)组明显低于≤2×ULN组;25(OH)D、L1-4骨密度、股骨颈骨密度在CT诊断不同程度脂肪肝组间比较差异均无统计学意义(P值均>0.05)。骨密度与HDL-C(r=0.232,P<0.05)呈正相关,与BMI(r=-0.271,P<0.05)、GLU(r=-0.242,P<0.05)、ALT(r=-0.375,P<0.05)、AST(r=-0.312,P<0.05)、LDL-C(r=-0.247,P<0.05)呈负相关。logistic回归分析结果显示,25(OH)D[比值比(OR)=1.113,95%可信区间(95%CI):1.023~1.210,P=0013]、BMI(OR=0.676,95%CI:0.522~0.877,P=0.003)、GLU(OR=0.350,95%CI:0.139~0.882,P=0.026)是NAFLD的影响因素。结论NAFLD患者血清维生素D及骨密度明显低于正常人,通过血清维生素D及骨密度的分析可进一步阐明NAFLD的骨代谢特征,对NAFLD并发骨质疏松症进行合理的早期筛查,以提高NAFLD患者的预后及生活质量。
【Abstract】:ObjectiveTo investigate the association of nonalcoholic fatty liver disease (NAFLD) with vitamin D and bone mineral density. MethodsA 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 (P1NP), 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. ResultsCompared 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), P1NP [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 well as 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. ConclusionPatients 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.
【关键字】:非酒精性脂肪性肝病; 维生素D; 骨密度; 骨质疏松; 危险因素
【Key words】:non-alcoholic fatty liver disease; vitamin D; bone density; osteoporosis; risk factors
【引证本文】:QU YL, WANG YC, WAN JX. Association of nonalcoholic fatty liver disease with vitamin D and bone mineral density[J]. J Clin Hepatol, 2019, 35(9): 2021-2025. (in Chinese)
曲玉蕾, 王迎春, 万金鑫. 非酒精性脂肪性肝病与血清维生素D及骨密度的关系[J]. 临床肝胆病杂志, 2019, 35(9): 2021-2025.

地址:长春市东民主大街519号《临床肝胆病杂志》编辑部 邮编:130061 电话:0431-88782542/3542
临床肝胆病杂志 版权所有 Copyright © 2009 - 2013 Lcgdbzz.org. All Rights Reserv 吉ICP备10000617号

吉公网安备 22010402000041号