The Clinical Observation Of Patients With Cirrhosis In Bone Metabolism Related Biochemical Index And Bone Mineral Density

Objectives:To observe the bone metabolism in patients with cirrhosis related biochemical index and bone mineral density changes,to explore the cause of abnormal bone mineral density,and to provide theoretical basis for the prevention and treatment of related complications.Methods:(1)the selection between January 2017 and December 2017 in Ganmei hospital affiliated to kunming medical university digestive internal medicine,liver and gallbladder surgery and geriatrics department a total of 98 cases of hospitalized patients,screening for and exclusion criteria of 55 patients with cirrhosis of the liver cirrhosis group,male 26 cases,female 29 cases,minimum age 28 years old,bigegest 75 years old,average(61.4±12.90).At the same time,the same period according to the inclusion and exclusion standard screening qualified 43 cases of hospitalized patients with control group,male 16 cases,female 27 cases,aged 31-75,average(56.94±9.31).Test the bone density of all the cases by determination of dual-energy X-ray absorptiometry(DEXA),and all the data were collected for statistical analysis.(2)All eligible cases should be collected fasting venous blood for serologic test in the next morning,according to the relevant venipuncture general considerations.Bone metabolism related indicators include:blood calcium and blood phosphorus,alkaline phosphatase and total vitamin D.Other laboratory indicators include:albumin,prothrombin time and total bilirubin.At the same time,doing abdominal ultrasound and clearing ascites in order to determine the liver function classification(Child-pugh).(3)Due to a decrease in the level of estrogen postmenopausal women,the majority of women after the age of 50 will appear different degree of abnormal bone mineral density.Therefore,this study by a 50 years old,disscuss the age and gender on the effects of changes in bone density in patients with cirrhosis.In the hepatic cirrhosis group,aged 28 to 50 have 11 cases,and over 50 years of age have 44 cases.In the control group,14 patients with 31 to 50 years old,29 cases over 50 years of age.At the same time,divided hepatic cirrhosis group into small groups,according to age,gender,Child-pugh,classification,etiology and course length.Collecting the result of bone metabolism related biochemical indicators and bone mineral density to the statistical analysis,and observing the changes of related biochemical index and bone mineral density.Result:(1)cirrhosis group compared with control group cases of abnormal bone mineral density,P<0.01,the difference was statistically significant.(2)Liver cirrhosis group,the incidence of osteoporosis was 45.5%,significantly higher than the control group 23.3%,P = 0.023<0.05,the difference was statistically significant.(3)Aged 27 to 50,the research object,the hepatic cirrhosis group the incidence of abnormal bone mineral density was 90%,the control group the incidence of abnormal bone mineral density was 46.7%,compared the two groups,P = 0.027<0.05,the difference was statistically significant;Aged 51 to 75 years of the research object,the hepatic cirrhosis group the incidence of abnormal bone mineral density was 88.9%,the control group the incidence of abnormal bone mineral density was 57.1%,compared the two groups,P = 0.002<0.05,the difference was statistical significance.(4)Of all the male patients,hepatic cirrhosis group the incidence of abnormal bone mineral density was 80.8%,the control group the incidence of abnormal bone mineral density was 31.3%,which contrast P = 0.002<0.05,with statistical significance;All female patients,the incidence of hepatic cirrhosis group of abnormal bone mineral density was 96.6%,the control group in the incidence of abnormal bone mineral density was 66.7%,which contrast P = 0.004<0.05,with statistical significance.(5)Bone metabolism related biochemical indexes,blood calcium:hepatic cirrhosis group is lower than the control group,P = 0.01<0.05,with statistical significance;Blood phosphorus:hepatic cirrhosis group is higher than the control group,P = 0.04<0.05,with statistical significance;Alkaline phosphatase:hepatic cirrhosis group was higher than the control group,P = 0.001<0.05,with statistical significance;Total vitamin D:hepatic cirrhosis group is lower than the control group,P = 0.038<0.05,with statistical significance.(6)hepatic cirrhosis group,Child-pugh class to C patients blood calcium and blood phosphorus,alkaline phosphatase,total vitamin D level is the most significant difference compared with patients with grade A,P values are less than 0.05,the difference was statistically significant.The comparision of different incidence of abnormal liver function in patients with bone density,P = 0.026<0.05,the difference was statistically significant.(7)Cirrhosis of the hepatic cirrhosis group,viral hepatitis,alcoholic liver cirrhosis,primary biliary cirrhosis of blood calcium and blood phosphorus,alkaline phosphatase,total incidence of vitamin D and osteoporosis were no statistical difference(P>0.05).And the comparison of the incidence of abnormal bone mineral density among the,P = 0.551>0.05,there was no statistically significant difference.(8)Patients with hepatic cirrhosis group,different duration of blood calcium and blood phosphorus,alkaline phosphatase,total vitamin D levels compare had no statistical difference(P>0.05);Grow along with the course of the disease and increase the incidence of abnormal bone mineral density,P = 0.038<0.05,with statistical significance;Incidence of osteoporosis and course length were positively correlated,within one year and more than five years in the comparison of the incidence of osteoporosis patients,P = 0.046<0.05,with statistical significance.Conclusions:(1)Liver cirrhosis group of bone mineral density measurement level significantly lower than that of control group with age,most of the patients with liver cirrhosis is of different degree of osteoporosis,and liver cirrhosis group,women are more likely to appear abnormal bone mass.(2)Compared with control group,the patients with cirrhosis of the decrease in the total blood calcium and vitamin D levels significantly higher blood phosphorus,alkaline phosphatase in different degree,the heavier and liver function damage,change,the more obvious.(3)With liver function damage grade A to C gradually aggravate,abnormalities in patients with bone mineral density increases,the incidence of osteoporosis incidence rate also increased,thus,bone mineral density results in patients with cirrhosis and negatively correlated with liver function damage.(4)Cirrhosis of the liver caused by different causes,bone metabolic biochemical indexes and no obvious correlation between bone mineral density results.The longer the course of the disease in patients with cirrhosis,the higher the incidence of abnormal bone mineral density,osteoporosis rate also increased obviously.