慢性胰腺炎和胰腺外分泌功能不全患者的骨矿物质代谢、骨矿物质密度和体成分。

A B Haaber, A M Rosenfalck, B Hansen, J Hilsted, S Larsen
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引用次数: 122

摘要

背景:囊性纤维化引起的外分泌胰腺功能障碍患者的钙和维生素D稳态似乎异常。只有少数研究评估和描述了慢性胰腺炎和胰腺功能不全患者的骨矿物质代谢。方法:32例慢性胰腺炎伴外分泌胰腺功能残余患者(1组)和26例胰腺外分泌功能不全患者(即饮食刺激的十二指肠内脂肪酶)结果:酒精是79%患者的病因。第一组56%和第二组69%的患者BMD z -score < -1。组1平均Z-score为-1.16 +/- 1.29,组2平均Z-score为-1.32 +/- 0.90。BMC的平均z评分为-1.02 +/- 1.17 vs -1.39 +/- 0.987。两组患者平均25(OH) D和平均1.25(OH)2D均低于参考范围。血浆白蛋白校正钙、碱性磷酸酶和甲状旁腺激素浓度均在参考范围的上端。1组LBM的平均z -评分为-0.69 +/- 1.34,2组为-1.01 +/- 1.12;1组FM的z -评分为-0.27 +/- 1.70,2组为-0.95 +/- 1.01 (p)结论:慢性胰腺炎患者,特别是晚期疾病和脂肪过流患者,存在发生显著骨质流失的风险。尽管身体质量指数正常,但患者的特点是瘦体质量和脂肪质量下降。目前的研究表明,这些患者血清中维生素D代谢物水平下降,骨量低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency.

Background: Calcium and vitamin D homeostasis seem to be abnormal in patients with exocrine pancreatic dysfunction resulting from cystic fibrosis. Only a few studies have evaluated and described bone mineral metabolism in patients with chronic pancreatitis and pancreatic insufficiency.

Methods: Thirty-two patients with chronic pancreatitis and residual exocrine pancreatic function (group 1) and 26 patients with pancreatic exocrine insufficiency (i.e., meal-stimulated intraduodenal lipase <10% of lowest normal range and steatorrhea) (group 2) were studied. Serum levels of total calcium, phosphate, 25 (OH)D, 1.25(OH)2D, alkaline phosphatase, and parathyroid hormone were measured. Bone mineral density (BMD), bone mineral content (BMC), lean body mass (LBM), and fat mass (FM) were measured using a dual-energy X-ray absorptiometry (DXA) scanner.

Results: Alcohol was a causative factor in 79% of the patients. Fifty-six percent in group 1 and 69% in group 2 had Z-scores of the BMD < -1. The mean Z-score was -1.16 +/- 1.29 in group 1 and -1.32 +/- 0.90 in group 2. The mean Z-score of the BMC was -1.02 +/- 1.17 vs -1.39 +/- 0.987. In both groups mean 25 (OH)D and mean 1.25(OH)2D were below reference range. Plasma concentrations of albumin-corrected calcium, alkaline phosphatase, and parathyroid hormone were in the upper range of the reference range. Mean Z-scores of LBM were -0.69 +/- 1.34 in group 1 vs -1.01 +/- 1.12 in group 2 and Z-scores of FM were -0.27 +/- 1.70 in group 1 vs -0.95 +/- 1.01 in group 2 (p <0.05).

Conclusion: Patients with chronic pancreatitis, in particular patients with advanced disease and steatorrhea, are at risk of developing significant bone loss. Despite normal body mass index the patients are characterized by loss of lean body mass and fat mass. The present study shows that these patients have decreased serum levels of vitamin D metabolites and low bone mass.

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