中老年慢性乙型肝炎患者HBV DNA载量与不同部位骨密度的关系研究

Association between HBV DNA Load and Bone Mineral Density at Different Sites in Middle-Aged and Elderly Patients with Chronic Hepatitis B

摘要: 目的：探讨未经抗病毒治疗的中老年慢性乙型肝炎(CHB)患者HBV DNA载量与不同部位骨密度(BMD)之间的关系，并分析其影响的部位及性别差异，为骨质疏松的早期筛查与风险分层提供依据。方法：本研究采用横断面设计，回顾性纳入2014年1月至2024年1月期间在青岛大学附属医院同期完成HBV DNA检测与双能X线骨密度检查的未抗病毒治疗慢性乙型肝炎患者(绝经后女性和年龄 ≥ 50岁男性)共362例。根据HBV DNA水平(界值为2000 IU/mL)将患者分为高病毒载量组(n = 141)与低病毒载量组(n = 221)。收集并分析两组患者的一般临床资料、血清学指标以及腰椎、股骨颈和全髋的骨密度T值。统计学分析采用t检验、分层分析、线性回归和Spearman相关分析进行组间比较与变量关联性评估。结果：高病毒载量组患者的腰椎、股骨颈及全髋骨密度T值均显著低于低病毒载量组。年龄分层分析显示，高病毒载量对骨密度的负向影响在男性患者中存在于各年龄段的各部位，而在女性患者中主要局限于腰椎。多因素线性回归分析显示，在校正混杂因素后，高病毒载量仍是各部位骨密度下降的独立危险因素。性别分层分析表明，在男性患者中高病毒载量与各部位骨密度均显著相关，其中对股骨颈影响最大；而在女性患者中病毒载量高低仅与腰椎骨密度独立相关。相关性分析进一步证实，病毒载量与股骨颈骨密度的负相关性最强(r = −0.401)，且在男性中这一关联尤为显著。结论：在未抗病毒治疗的中老年慢性乙型肝炎患者中，高HBV DNA载量是骨密度下降的独立危险因素，其影响呈现明确的性别模式：在男性中表现为跨年龄段、多部位的广泛影响，以股骨颈最为显著；在女性中则主要累及腰椎。本文为回顾性探索性结论，尚需前瞻性研究进一步验证。

Abstract: Objective: To investigate the relationship between HBV DNA load and bone mineral density (BMD) at different sites in middle-aged and elderly patients with chronic hepatitis B (CHB) who have not received antiviral therapy, and to analyze the site-specific and sex-specific differences of this impact, thereby providing a basis for early screening and risk stratification of osteoporosis. Methods: This cross-sectional study retrospectively enrolled 362 treatment-naive CHB patients (postmenopausal women and men aged ≥ 50 years) who concurrently underwent HBV DNA testing and dual-energy X-ray absorptiometry (DXA) at The Affiliated Hospital of Qingdao University between January 2014 and January 2024. Patients were divided into a high viral load group (n = 141) and a low viral load group (n = 221) based on an HBV DNA cutoff of 2000 IU/mL. General clinical data, serological markers, and BMD T-scores of the lumbar spine, femoral neck, and total hip were collected and analyzed. Statistical analyses included t-tests, stratified analysis, linear regression, and Spearman correlation for intergroup comparisons and association assessments. Results: BMD T-scores at the lumbar spine, femoral neck, and total hip were significantly lower in the high viral load group compared to the low viral load group. Age-stratified analysis revealed that the negative effect of high viral load on BMD was present across all age groups and sites in male patients, whereas in female patients, it was primarily confined to the lumbar spine. Multivariate linear regression analysis, after adjusting for confounders, confirmed that high viral load remained an independent risk factor for BMD reduction at all sites. Sex-stratified analysis indicated that in male patients, high viral load was significantly associated with lower BMD at all sites, with the strongest effect observed at the femoral neck. In contrast, in female patients, viral load was independently associated only with lumbar spine BMD. Correlation analysis further confirmed that viral load showed the strongest negative correlation with femoral neck BMD (r = −0.401), and this association was particularly pronounced in males. Conclusion: In treatment-naive middle-aged and elderly CHB patients, high HBV DNA load is an independent risk factor for decreased BMD. Its impact demonstrates a distinct sex-specific pattern: a widespread, multi-site effect across all age groups in men, most notably at the femoral neck, while primarily affecting the lumbar spine in women.