pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2007-0-3-48-55pulmo-1925Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESСостояние минеральной плотности кости у больных хронической обструктивной болезнью легкихBone mineral density in patients with chronic obstructive pulmonary diseaseДворецкийЛ. И.DvoretskyL. I.

г. Москва

ЧистяковаЕ. М.ChistyakovaE. M.

г. Москва

РубинМ. П.RubinM. P.

г. Москва

ММА им. И.М.Сеченова; ГКБ № 23Russian Federation200728062007034855Copyright © Дворецкий Л.И., Чистякова Е.М., Рубин М.П., 20072007Дворецкий Л.И., Чистякова Е.М., Рубин М.П.Dvoretsky L.I., Chistyakova E.M., Rubin M.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1925

Одним из внелегочных проявлений ХОБЛ является остеопороз. Целью настоящего исследования явилась оценка состояния минеральной плотности кости (МПК) у больных ХОБЛ и выявление связи с различными факторами риска. В исследовании участвовали 46 больных с различными стадиями ХОБЛ, средний возраст 64,3 ± 7,8 года (28 женщин в менопаузе, 18 мужчин). 15 больных получали ингаляционные глюкокортикоиды (иГК) 500–2000 мкг/сут в пересчете на беклометазон в течение 5–8 лет. Контрольную группу составили 38 пациентов: 35 женщин в постменопаузальном периоде и 3 мужчины, сравнимых по возрасту, стажу курения, наличию и характеру сопутствующих заболеваний, но без ХОБЛ. МПК поясничного отдела позвоночника и проксимальных отделов обеих бедренных костей определяли методом рентгеновской двухэнергетической абсорбциометрии. Остеопения выявлена у 20 (43,48 %) больных, остеопороз — у 11 (23,91 %) больных ХОБЛ. Среднее значение Т критерия в поясничных позвонках и шейках правой и левой бедренных костей у больных ХОБЛ было достоверно ниже, чем в группе контроля (р = 0,0010 — 0,0024). МПК поясничных позвонков (р = 0,0005 — 0,006) и шеек обеих бедренных костей (р = 0—0,007) была ниже у больных ХОБЛ по сравнению с контрольной группой. Высота поясничных позвонков у больных ХОБЛ и в контрольной группе достоверно не отличалась. При выделении группы больных тяжелой ХОБЛ (ОФВ1 , %долж. < 50) получено, что у них остеопения и остеопороз встречались чаще (52,6 % против 37 % и 36,8 % против 14,8 % соответственно), показатели Т критерия и МПК в поясничных позвонках и шейке бедренной кости были достоверно ниже, чем при легкой и среднетяжелой ХОБЛ. Это позволяет предположить роль гипоксии в развитии остеопороза. Показана корреляция между индексом массы тела (ИМТ) и показателями Т критерия в поясничных позвонках и шейке бедренной кости (r = 0,453–0,743, р = 0), МПК поясничных позвонков и шейки бедренной кости и ИМТ (r = 0,425–0,663; p = 0). Не выявлена связь между кумулятивной дозой ИГК и показателями МПК. Отсутствие половых различий в показателях МПК свидетельствует, что потеря МПК у больных ХОБЛ связана именно с хронической легочной патологией, а не с дисгормональными нарушениями. Таким образом, потеря МПК является одним из системных проявлений ХОБЛ.

Osteoporosis is one of extrapulmonary features of COPD. This study was aimed to evaluate bone mineral density (BMD) and its correlation to risk factors in patients with COPD. Forty six patients (28 postmenopausal females, 18 males, the average age, 64.3 ± 7.8 yrs) with different COPD stages participated in the study. Fifteen patients have received inhaled corticosteroids (ICS) 500 to 2000 μg of beclomethasone equivalent daily for 5 to 8 yrs. The controls were 38 non COPD patients (35 postmenopausal females, 3 males) comparable to age, smoking history, and co morbidity. BMD was measured in lumbar vertebrae and proximal parts of right and left hips using X ray dual energy absorptiometry. Osteopenia was found in 20 COPD patients (43.48 %) and osteoporosis was in 11 (23.91 %) ones. The mean T criterion in lumbar vertebrae and both femoral necks of COPD patients was significantly lower compared to controls (р = 0.0010–0.0024). BMD in lumbar vertebrae (р = 0.0005–0.006) and femoral necks (р = 0–0,007) was also lower in COPD patients. Lumbar vertebra height did not differ in COPD patients and the controls. We also analyzed sub-groups of severe (FEV1 < 50 %pred.) and mild to moderate COPD patients separately. Those with severe COPD had osteopenia and osteoporosis more often (52.6 % vs 37 % and 36.8 % vs 14.8 %, respectively) and T criterion and BMD in both sites reliably lower. These results suppose a role of hypoxia in development of osteoporosis. Both T criterion and BMD in all sites correlated with body mass index (r = 0,453–0,743, p = 0; and r = 0,425–0,663; р = 0, respectively). There was no correlation between cumulative dose of ICS and BMD. No gender differences of BMD in COPD patients indicated that the loss of BMD in COPD could be relevant to chronic pulmonary disease but not to hormonal disorders. We conclude that loss of BMD is one of the systemic effects of COPD.

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The authors declare that there are no conflicts of interest present.