Study On The Correlation Between PBC And Osteoporosis And Clinical Multidimensional Analysis

ObjectivesTo investigate the correlation between PBC and osteoporosis and the relationship between the severity of PBC and the risk of osteoporosis.To investigate the therapeutic effect of bisphosphonates on osteoporosis.To investigate the correlation between serum markers of bone metabolism and osteoporosis and its potential value in monitoring the efficacy of anti-osteoporosis.MethodsA total of 87 patients with PBC with complete bone mineral density,serum bone metabolism index,liver reserve function DDG,liver transient elastic imaging(FibroTouch),liver biopsy and related auxiliary examination data were selected in the Department of Gastroenterology of the Second Affiliated Hospital of Kunming Medical University from November 2018 to December 2020.Thirty-five PBC patients with osteoporosis were in the osteoporosis group,and 29 patients with normal bone mass were in the control group.The two groups were compared in terms of general data(sex,age,hormone use,history of basic diseases(history of hypertension,type 2 diabetes,thyroid disease,history of coronary heart disease)and results of blood biochemical examination(alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,glutamyltransferase,total bilirubin,total bile acid,total cholesterol,triglyceride,creatinine,uric acid,calcium,phosphorus),erum bone metabolism test results(Determination of N-terminal molecular fragment of osteocalcin,type Ⅰ procollagen N-terminal propeptide,β-C-telopeptide of type Ⅰcollagen,25 hydroxy vitamin D,calcitonin,parathyroid hormone,Bone Alkaline Phosphatase),liver reserve function,liver transient elastic imaging(Fibro Touch)and liver biopsy.PBC patients were divided into osteoporosis and normal bone mass groups according to the results of bone mineral density.PBC patients were divided into stage 1,stage 2,stage 3 and stage 4 groups according to the results of liver biopsy.To investigate the relationship between PBC and osteoporosis and the relationship between its severity and the risk of osteoporosis.To analyze the correlation between serum markers of bone metabolism and osteoporosis and its potential value in the evaluation of anti-osteoporosis therapeutic efficacy and disease monitoring.The count data-expressed by example and constituent ratio,the skewness distribution measurement data-expressed by InterQuartile Range,the normal distribution measurement data-expressed by mean± standard deviation.The t-test was used for comparison of normally distributed continuous data between two groups;The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the Kruskal-Wallis H test was used for comparison between multiple groups;the chi-square was used for comparison of count data between two groups;the ROC curve was used for diagnostic test,A logistic regression analysis was used to investigate the risk factors of PBC complicated with osteoporosis,P<0.05 indicated that the difference was statistically significant.Results1.The proportion of osteoporosis in PBC group was higher than that in hepatitis B group(P<0.05).2.Compared with the normal bone mass group,the osteoporosis group group had significantly higher levels of age mean,menopausal time,BMI,history of hypertension,hormone use history,TCHOL and TBA(P<0.05).There was no statistically significant difference in gender,diabetes history,coronary heart disease history,thyroid disease history,ALT,AST,ALP,GGT,TBIL,TG,CREA and UA between the two groups(P>0.05).3.Compared with the normal bone mass group,the osteoporosis group group had significantly higher levels of ICG 5-minute retention rate,ICG 10 minute retention rate,ICG 15 minute retention rate,median liver stiffness,histological stage ofliver transient elastic imaging,child Pugh score and pathological stage of liver puncture,ICG plasma clearance rate and effective liver blood flow were lower than those in normal bone mass group(P<0.05).There were no significant differences in mean circulation time and median fat attenuation(P<0.05).4.Multivariate logistic regression analysis was used to analyze the influencing factors of PBC complicated with osteoporosis.The results showed that age[odds ratio(OR)=3.26,95%confidence interval(95%CI):1.84～5.76],BMI(OR=2.65,95%CI:1.23～5.70),history of hypertension(OR=1.19,95%CI:1.03～1.39),and hormone use(OR=81.4,95%CI:11.79-562.21)and child-Pugh score(OR=15.78,95%CI:2.12-117.66)were independent risk factors for osteoporosis in PBC patients(P<0.05)were independent risk factors for PBC combined with osteoporosis.5.The T value of bone mineral density,VitD-250H,CT and PINP levels of PBC patients combined with osteoporosis were higher than those before treatment,while the levels of β-CTX and BALP were lower than those before treatment(P<0.05).There was no significant difference in the levels of N-MID,Ca and IP(P>0.05).6.The levels of N-MID,VitD-250H,Ca and IP in PBC osteoporosis group were lower than those in normal bone mass group,while the levels of β-CTX,PlNP and BALP were higher than those in normal bone mass group(P<0.05).There was no significant difference in the levels of CT and PTH(P>0.05).7.ROC curve:area under the curve of N-MID for diagnosis of osteoporosis=0.76,sensitivity=0.83,specificity=0.72,the best diagnostic value=18.94(ng/ml),area under the curve of β-collagen degradation products for diagnosis of osteoporosis=0.74,sensitivity=0.71,specificity=0.76,the best diagnostic value=6.90(PG/ml).Both of them have better diagnostic effect on PBC combined with osteoporosis.Conclusions1.PBC is a risk factor of osteoporosis.2.Patients with PBC is heavier,the higher the risk of osteoporosis.3.Age,long menopause time,BMI,history of hypertension,hormone use,TCHOL and TBA were the influencing factors of PBC patients combined with osteoporosis.Multivariate logistic regression analysis showed that age,BMI,history of hypertension,hormone use and child Pugh score were the independent risk factors of PBC patients combined with osteoporosis.4.After alendronate+calcitriol+calcium carbonate D3 anti osteoporosis treatment for half a year,the VitD-250H level was significantly higher than that before treatment,and the levels of β-CTX and BALP were lower than that before treatment,but the bone mineral density was not significantly improved.5.Serum bone metabolism indexes such as N-MID,VitD-250H,Ca,IP,β-CTX,PlNP and BALP have good correlation with osteoporosis.Monitoring the levels of the above indexes has great significance for preventing osteoporosis in PBC patients and evaluating the efficacy of anti-osteoporosis.ROCcurve shows N-MID and β-CTX have better diagnostic effect on PBC combined with osteoporosis.