Журнал «Боль. Суставы. Позвоночник» Том 14, №2, 2024

Актуальність. Згідно з рекомендаціями GOLD при загостреннях хронічного обструктивного захворювання легень (ХОЗЛ) доцільне призначення глюкокортикоїдів (ГК), які в терапевтичній дозі можуть знижувати мінеральну щільність кісткової тканини (МЩКТ). Мета: визначити вплив ГК на МЩКТ і частоту глюкокортикоїд-індукованого остеопорозу у хворих на ХОЗЛ залежно від призначеної терапії. Матеріали та методи. Обстежено 202 пацієнти з ХОЗЛ групи Е у фазі загострення. І групу становили 129 хворих, які приймали базисну подвійну терапію, ІІ групу — 73 пацієнти, які приймали потрійну терапію з використанням інгаляційних ГК. При загостренні призначали системні ГК у кумулятивній дозі 352,94 ± 30,51 мг/рік. Досліджували кісткову тканину з використанням денситометра SONOST-2000, вимірюючи швидкість поширення ультразвуку (ШПУ), широкосмугове ослаблення ультразвуку (ШОУ), індекс міцності (ІМ) кісткової тканини, T- і Z-індекси. Результати. Встановлено зниження ІМ, ШОУ, Т- і Z-показників у 43,51 % обстежених І групи і 83,56 % ІІ групи (р < 0,05). У ІІ групі ІМ був нижчим на 9,54 %, ШПУ — на 14,35 %, ШОУ — на 14,57 %, Т-критерій — на 6,9 %, Z-критерій — на 25,86 %; при GOLD 3: ШОУ — на 40,27 %, ІМ — на 3,25 %, Т-критерій — на 17,9 %; при GOLD 4: ІМ — на 19,9 %, ШОУ — на 77,8 %, Т-індекс — на 5,6 % порівняно з показниками І групи. Висновки. За даними ультразвукової денситометрії, глюкокортикоїд-індукований остеопороз діагностовано в 10,71 % хворих І групи і 20,55 % хворих ІІ групи, при цьому його частота залежала від стадії ХОЗЛ: при GOLD 3 він виявлявся в 22,22 % обстежених осіб, при GOLD 4 — у 50,0 %.

Background. According to the GOLD guidelines, glucocorticoids (GCs) are recommended for exacerbations of chronic obstructive pulmonary disease (COPD). Bone mineral density (BMD) can be reduced in case of the use of therapeutic doses of GCs. The aim of the study was to determine the influence of GCs on BMD and the frequency of osteoporosis in patients with COPD depending on the prescribed therapy. Materials and methods. We examined 202 patients with COPD (group E) in the acute phase. Group I consisted of 129 patients taking basic dual treatment, group II — 73 patients taking triple therapy with inhaled GCs. During exacerbations, systemic GCs were prescribed at the cumulative dose of 352.94 ± 30.51 mg/year. The bone state was examined using an ultrasound densitometer SONOST-2000. A Speed of Sound (SOS), Broadband Ultrasound Attenuation (BUA), Stiffness index (SI), and T- and Z-scores were determined. Results. Decreases in SI, BUA, T- and Z- scores were established in 43.51 % of the patients from the I group and 83.56 % from the II group (p < 0.05). In the II group, SI was lower by 9.54 %, BUA — by 14.35 %, SOS — by 14.57 %, T- score — by 6.9 %, Z- score — by 25.86 %; in subjects with GOLD 3: BUA — by 40.27 %, SI — by 3.25 %, T- score — by 17.9 %; in patients with GOLD 4: SI — by 19.9 %, BUA — by 77.8 %, T- score — by 5.6 % compared to the I group. Conclusions. Glucocorticoid-induced osteoporosis was diagnosed in 10.71 % of patients from the I group and 20.55 % of the II group. Its frequency depended on the stage of COPD: GOLD 3 — in 22.22 % of patients, GOLD 4 — in 50.0 % of the subjects.

хронічне обструктивне захворювання легень; глюкокортикоїди; мінеральна щільність кісткової тканини; остеопороз

chronic obstructive pulmonary disease; glucocorticosteroids; bone mineral density; osteoporosis

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